7 V Abstract The goal of the current thesis is to contribute to the knowledge base that will improve services to prevent reading and writing difficulties in chiidren. An approach influenced by both the cognitive sciences and the social sciences was adopted in order to consider not only the learning of emergent literacy skills in children, but also the practices ofadults in line with this acquisition. The first article reports on the resuits of a preliminary survey of the practices of 151 Canadian speech-language pathologists regarding the prevention of reading and writing difficulties. Most of the participants engaged in prevention of reading and writing difficulties in chiidren, but they devoted littie of their time to it. They reported that they provide both direct and indirect services, work in collaboration with other early childhood practitioners and engage in activities targeting a variety of emergent literacy components in chiidren from diverse subgroups of the population. The value of addressing emergent literacy components that are less traditional to speech-language pathology and ofproviding services for at-risk populations is discussed. The second article reports on the effects of two shared storybook reading programs on vocabulary, print awareness, and phonological awareness, skills considered to be predictors of reading achievement. Resuits show the superiority of an experimental enriched shared-storybook reading program over an evidenced-based control program in accelerating phonological awareness development in at-risk chiidren. The strategies from the experimental program could be introduced in existing shared storybook reading activities in daycares. The third article includes two experiments that demonstrate the sensitivity and the psychometric properties of the Épreuve préscolaire de conscience phonologique, phonological awareness assessment instrument for French-speaking 4- to 5-year-olds. Ibis

8 vi instrument has the potential to become a useful tool for researchers and clinicians working with French-speaking preschoolers in the area of emergent literacy. The complementary perspectives of social sciences and cognitive sciences allowed new knowledge related to the emergent literacy skills to be generated and to contextualize this knowledge into real practices. This link between theory and practice provides evidence-based data more applicable by clinicians. The results from the three articles contribute to solving the challenge of promoting evidence-based practices in prevention of reading and writing difficulties in chiidren. Keywords Reading and writing, prevention, preschoolers, emergent literacy, language skills, professional practices, intervention efficacy, measurement instrument, phonoïogicaï awareness

50 Abstract This preliminary study surveyed the practices of 151 Canadian speech-language pathologists ($LPs) regarding the prevention of reading and writing difficulties. Using a questionnaire, the survey addressed the scope of their preventive practice, the nature of the activities they use in prevention, and their perception of their training in this domain. Most of the participants engaged in prevention of reading and writing difficulties in chiidren, but they devoted littie of their time to it. They reported that they provided both direct and indirect services. They worked in collaboration with other early childhood practitioners to provide activities targeting a variety of emergent literacy components in chiidren from diverse subgroups of the population. The evaluation of their training was divided and they actively sought out additional sources of training. The value of addressing emergent literacy components that are less traditional to speech-language pathology and of providing services for at-risk populations is discussed. Specific recommendations for further studies are provided.

51 Introduction In North America, speech-language pathologists (SLPs) working with chiidren have been aware of the relationship between oral language abilities and reading and writing, but it is only in the early 90 s that many of them started to introduce literacy into their clinical practice (Butier, 1999). In Canada, no national guidelines exist about the role of SLPs in reading and writing for chiidren, even though knowledge and competencies in literacy are now mandatory for certification of clinical competency (Canadian Association of Speech Language Pathologists and Audiologists, 2004). No specific guiding principles are provided with respect to prevention of reading and writing difficulties (R&WD). Because of initial training and clinical expertise in linguistic components that underlie reading and writing, SLPs have been called upon to play a role in improving prevention efforts in reading and writing, especially in chiidren with oral language impairments (Fey, 1999; Snow, Scarborough, & Bums, 1999). Justice (2006) argues that SLPs can become more powerful catalysts for prevention of R&WD if they go beyond providing services for chiidren already identified with language impairments. Given the paucity of information about the practices related to prevention of R&WD in Canada, the purpose of this article is to provide a first glimpse of these practices in Canadian speech-language pathologists in order to lay the foundations for a more detailed study. Several ways of conceptualizing prevention exist in health and education fields. The classic terminology proposed by the Commission of Chronic Illness (1957), includes three levels of prevention: 1) primary, to reduce the number of new cases with problems; 2) secondary, to reduce the number of existing cases with problems; and 3) tertiary, to reduce the impact of an identified problem. More recently, Weisz, Sandier, Durlak, and Anton (2005) make a clearer distinction between prevention and intervention: secondaiy and tertiary prevention activities should be classified as intervention rather than prevention because they target children with diagnosable problems. The term primary prevention is

52 32 resenred for efforts that can reduce the incidence of probiems before they appear. Weisz et al. also use the same terminology as Gordon (1987) and the Committee on Prevention of Mental Disorders of the Institute of Medicine (Mrazek & Haggerty, 1994), distinguishing between three types of primary preventive strategies: (a) universai prevention to address risk factors in the population at large, (b) selective prevention for subgroups of the population who share a significant risk of developing a probiem, and (c) indicated prevention aimed at chiidren who have significant symptoms of a problem, but do flot currentiy meet diagnostic criteria. In addition, Weisz et al. s framework focuses on heaith promotion, the goal of which is to strengthen positive behaviours that prevent probiems in ah populations. These authors also propose that the level of prevention should be proportionate to the level of risk, that is, universal and selective prevention shouid require iess direct and intensive service delivery than indicated prevention or intervention. The Weisz et al. (2005) framework is highly relevant to R&WD because its conceptualization of prevention is in une with the report of the U.S. National Research Council s Committee on the Prevention of Reading Difficulties in Young Chiidren (Snow, Bums, & Griffin, 1998). Recognizing that the process of becoming literate begins before formai instruction in school, this committee recommends universal prevention through promotion of oral language and emergent iiteracy skiils in ail eariy chiidhood environments. Its report also focuses on groups of chiidren from lower income families, from linguistic minorities, or with a familial history of reading and writing probiems, who are more likely to develop reading and writing difficulties (Duncan & Brooks-Gunn, 1997). Selective prevention activities wouid be appropriate for these chiidren, and would include professional, family or preschool-focused programs to improve emergent hiteracy skihls known to be predictors of reading success, such as letter knowledge, phonological awareness, print awareness, and oral language skihls (Hammili, 2004). Snow et al. also encourage indicated measures through a more direct and intensive approach targeting chiidren whose symptoms appear prior to the diagnosis of R&WD, for exampie, chiidren

53 33 with cognitive, hearing or early language impairments (Catts, Fey, Zhang, & Tomblin, 2001). Although Canadian SLPs do flot have national guidelines in regards to prevention of R&WD, they may be influenced by the guidelines provided in the United States. In its position statement and guidelines on services in reading and writing for chiidren and adolescents, the American $peech-language-hearing Association (ASHA) clearly states that SLPs have a major role to play in the prevention of reading and writing difficulties (ASHA, 2001a, 2001b). According to these guidelines, prevention of R&WD should be accomplished through stimulation of oral language and emergent literacy skills. Adequate skills in vocabulary, syntax, morphology and pragmatics, and development of emergent literacy skills are supportive of reading and writing development because they are good predictors of reading and writing achievements (Hammiil, 2004; National Early Literacy Panel, 2004). ASHA highlights eight components of emergent literacy to be addressed in order to prevent reading and writing problems: ta) joint-book reading: strategies to make reading interactive and pleasurable for children, providing access to books; (b) environmental print awareness: recognition of logos, symbols, or signs; (c) conventions of print: direction of reading, orientation of books, space in between words, and punctuation; (d) phonological awareness and sensitivity: rhymes, alliterations, phoneme and syllable games; (e) alphabetic/letter knowledge: letters, numbers, frequent words, sorting words by letters; (f) sense of story (narrative structure): logical and temporal sequence of events in narratives; (g) adult modeling of literacy activities: examples of real actions related to literacy and the daily use of writing; and (h) experience with writing materials: access to paper and pencils to scribble, copy and pretend to write. ASHA supports both direct and indirect service delivery. Along a continuum from indirect to direct service, types of service deliveiy include: (a) information for the public, parents, professionals, or preschool practitioners about the development and the stimulation

54 34 of oral language and emergent iiteracy skills; (b) coaching of parents or caregivers to provide stimulation of oral language and emergent literacy skills; (c) early stimulation of oral language and emergent literacy skills directly with chiidren. Roth and Baden (2001) proposed direct service delivery for children with lmown language disorders and indirect service delivery for ail chiidren through collaborative consultation and education of professional staff, parents, the community, and policy makers. ASHA encourages SLPs to collaborate with other early childhood practitioners in their prevention efforts. In fact, everyone involved in the education of the children, regardless of their area of expertise, must collaborate in order to ensure future reading and writing achievement for as many children as possible (Silliman & Wilkinson, 2004). That way, young children can have many opportunities to develop their oral language and emergent literacy skills in multiple environments. However, in order for $LPs to take a role in literacy-related prevention, ASHA (2001a) recommends that university programs should provide students in speech-language pathology with coursework and clinical placements in reading and writing. Snow et al. (1999) highlighted the importance of continuing education programs for $LPs already working in the field to help them to introduce prevention of R&WD into their current practices. Therefore, university training and continuing education opportunities may influence the extent and the nature of their activities in prevention of R&WD. Thus, although it is clear that SLPs have a role to play in prevention of R&WD, little information is available on their current preventive practice with preschoolers and their families. A few studies have examined SLPs practices regarding assessment and intervention in reading and writing with school-aged children. In the United States, Staskowski and Zagaiski (2003) report that the integration ofreading and writing in speech language pathology practice is variable, for a number of years, some have incorporated literacy into their practice, while others are just starting to introduce it. Coe Hammond, Prelock, Roberts, and Lipson (2005) found that SLPs in Vermont Schools felt fairly

55 35 knowledgeable about literacy and rated their competency as adequate, even though they feit more confident working in more traditional areas of speech-language pathology like phonological awareness and vocabulary. Those working in collaboration with other school staff members and those with more years of experience tended to rate their knowledge and competency in reading and writing higher. In a preliminary study surveying 12 school based SLPs from the Midwest and Mid-Atlantic regions of the United $tates, Katz, Fallon, DiDonato and Van Der Linden (2006) found that 70% of the participants believed that reading and writing were within their scope of practice. Slightly more than haif of the participants worked in collaboration with teachers and used mixed groups in the classroom. $LPs reported using a wide range of specffic literacy practices for both assessment and intervention. The majority of them targeted phonological awareness, vocabulary and reading comprehension. The literature to date concems the practices of SLPs in schools for whom intervention with chuidren already showing R&WD represents a main aspect of their mandate, but prevention of these difficulties has not been directly examined. Further, practices in Canada specifically have flot been studied. In order to provide an initial portrait of how recommendations and guidelines of regulatory agencies in the United $tates translate into clinical practice in Canada, and to lay the foundations for a more detailed study, a preliminary study on Canadian SLPs practices regarding prevention of R&WD was conducted. More precisely the study pursued four goals: (a) to obtain a first measure of the extent of practices in prevention of literacy difficulties among some Canadian SLPs, (b) to describe the nature of the preventive activities these SLPs use according to the type of service delivery they offer, the emergent literacy components and the clienteles they target, and the collaborations they establish, (c) to explore the perception of these SLPs regarding their training in prevention of R&WD, and (d) to identify modifications needed to guide further more detailed studies.

56 Metliods Study Design To address the four goals of the current study, a survey approach was used. Surveys can effectively provide a quick description of the characteristics of a population and examine the distribution of specific attributes within this population (Babbies, 1990) Participants Advertisements inviting SLPs to participate to the survey were sent by mail or e- mail via provincial and national professional associations and regulatory colleges of Canada. SLPs working in Canada with preschoolers (0-6 year-olds), including children in kindergarten, were eligible to participate. Participants downloaded the questionnaire and a consent form in either English or french from a website. They filled out both documents and faxed or mailed them back to the first author. This somewhat cumbersome procedure was needed in order to have their signature on the consent form, a condition required to obtain approval from the local ethics board. A total of 154 participants responded to the suwey. Three completed surveys were eliminated, because they were unreadable (n = 2) or the consent fonri was flot filled out (n = 1). The data from 151 SLPs were analysed. More than half of the respondents (5 6.6%) worked in the province of Quebec and most of these participants used only French in their practice. The other respondents (43.4%) came from the other provinces and territories of Canada and, in most cases used, only English in their practice (10.7% from Ontario, 10.7% from Alberta, 6.0% from New Bmnswick, 6.7% from British-Columbia, 4.7% from Newfoundland and Labrador, 1.3% from Nova $cotia, 1.3% from Saskatchewan, 1.3% from Manitoba, and 0.7% from Northwest Territories). Similar proportions of participants worked in preventive healthcare facilities (36.7%: 33.3% in community health centers and

57 37 3.3% in extra-mural programs or community organisations) and in curative healthcare facilities (36.7%: 15.3% in rehabilitation centers, 14.0% in hospitals, and 7.3% in private practice). Roughly a quarter (26.7%) worked primarily in education facilities. Two-thirds (66.6%) of the participants had graduated before 2000, when guidelines concerning reading and writing within speech-language pathology were published (6.7% in the 1970s, 16.7% in the 19$Os, 42.7% in the 1990s, and 34.4% in the 2000s) Materïals Given that questionnaires are recommended for data collection about professional practices (Schiavetti & Metz, 2002), the survey was conducted through an electronic questionnaire (Appendix A) developed by the researchers, and modified following preliminary testing. Multiple choice questions were used to facilitate responding and the subsequent analyses as prescribed by Silverman (1998) and Chadwick, Bahr, and Albrecht (1984). The questionnaire included three parts. The first part, Demographic Information, contained questions about the participant s province, language used in practice, work setting, and decade of graduation. The second part, Speech-Language Pathology Practice, contained questions about the amount of time dedicated to prevention and, more specifically, to prevention ofr&wd. This information addressed the first goal ofthe study. Participants who devoted part of their time to the prevention of R&WD then described the preventive activities that they provide. This section included aspects of the activities that were highlighted by ASHA guidelines (2001b) and the U.S. National Research Council s Committee on the Prevention of Reading Difficulties in Young Chiidren ($now, Bums, & Griffin, 1998). Preventive activities were classified as one of three types of service delivery: ta) information for parents and early childhood workers, (b) coaching of parents or caregivers to provide stimulation, and (c) early stimulation directly with children. For each type of service delivery used, participants were asked to identify the components of emergent literacy they targeted. These components were taken from A$HA (200 la), and a language component was added in order to take into account the importance of oral

58 38 language skills in prevention of R&WD in addition to stimulation of emergent literacy skills (ASHA, 200 la). Participants were also asked to indicate the age group of the clienteles they served and the types of prevention they offered: universal for chiidren from the general population, selective for chiidren from at-risk groups, and indicated for chiidren showing symptoms of future literacy problems (Weisz et al., 2005). Participants also described in this section the type of practitioners with whom they collaborate during their preventive activities. The information related to the types of service delivery, the targeted emergent literacy components, the targeted clienteles, and collaboration addressed the second goal of the study. The last section, Training, contained questions conceming the sources of training in the prevention of R&WD, as well as the respondents rating of this training from poor to excellent. The training information was gathered to address the third goal of the study. A glossary (Appendix B) including definitions largely inspired from ASHA (200 lb) and Weis et al. (2005) was available at the end of the questionnaire to ensure that the questions were clear. Both English and French versions of this glossaiy were field tested by two SLPs. Following their questions and comments, clarifications were made to the original definitions to make them clearer Procedures Responses from each survey were entered in a Microsoft Excel table by the first author. Responses to multiple choice questions were given numerical categorical values except for percentage of work time which was entered as a continuous value. Reliability was established by having a research assistant familiar with the project verify all entered data. This verification showed that the data entry was 100% correct Analyses Descriptive statistics including proportions for categorical variables and means and standard deviations for continuous variables were used to present the resuits in each section

59 39 about $LPs practices in prevention of R&WD. To verify if the difference between proportion of work time dedicated to prevention of R&WD and of oral language difficulties was significant, a paired t test was used because both variables came from the same sample. Each analysis was based on the number of participants responding to the question; if a participant skipped one question, he or she was flot included in the analysis for that question only. Ail statisticai analyses were performed using SPSS version 14.0 for Windows (SPS$, 2005). 3.4 Resuits Preliminary comparisons of the scope of practice, the nature of the activities, and the training between participants from the province of Quebec and those from the other provinces and territories of Canada were made because aimost the half of the participants were from Quebec. There were no statistically significant differences between the two groups for scope of practice and training. The few differences that were identified were related to more detailed aspects of the nature of the activities they provided, but the overall direction of theses resuits remained the same between the two groups. For example, fewer participants from Quebec (70%) than from the other provinces and territories of Canada (94%) targeted joint-book reading, but in both groups, joint-book reading was stiil one of the emergent literacy components targeted by at least 50% of the participants. Given the preliminary nature of the study and that the differences observed were relatively minor, the analyses presented here included all participants in a single sample Scope of Practice Prevention, defrned in the questionnaire as the set of activities which prevent the emergence of oral language and!or reading and writing difficulties, includes activities prior to any evaluation or intervention plan, which aim at establishing favourable conditions to support the maximal development of oral language and!or reading and writing in children.

60 40 The scope ofthis preventive practice was measured in two ways: percentage of participants engaged in prevention of R&WD, and percentage of their work time dedicated to it. Roughly the same percentage of participants engaged in the prevention of R&WD (8 1.8%) as in the prevention of oral language difficulties (80.1%). Those who did engage in prevention ofr&wd (n = 121) spent only a mean of 12.3% (3D = 10.5) oftheir time on it, halfthe time on average spent on prevention of oral language difficulties (M= 23.3%, 3D = 24.3). This difference was significant, paired t(1 10) = 4.78,p < Nature of the Activities The following analyses examined different facets of the activities by the 121 participants engaged in prevention ofr&wd Types of Service Delivery The first analysis examined the types of service deiivery provided. Participants provided ail three types of service delivery, although slightiy more offered information (86.0%) and direct stimulation (83.5%) than coaching (7 1.9%) Targeted Emergent Literacy Components The second set of analyses examined the emergent literacy components targeted by the activities. At ieast 50% of the SLPs engaged in prevention of R&WD engaged in joint book reading (80.2%), phonological awareness (8 1.8%), and sense of story (56.2%). The other components were ail addressed by less than 30% of the participants: oral language (28.9%), environmental print awareness (27.3%), conventions of print (26.4%), experience with writing material (27.3%), aduit modeling of literacy activities (20.7%), and alphabet knowledge (19.0%). Inspection of Table I shows that joint book reading, phonoiogical awareness and sense of story were the three most frequently targeted emergent iiteracy components across

61 41 ail three types of service deiivery. Joint-book reading tended to be addressed indirectly through provision of information, while phonological awareness tended to be addressed directly through stimulation. Sense of story tended to be addressed through stimulation and coaching. Table I: Percentage of Participants Using Each Type of Service Deiivery to Target Emergent Literacy Components Type of service delivery Information Coaching Stimulation Emergent literacy components (n = 105) (n = 87) (n = 101) Joint-bookreading Phonological awareness Sense ofstory Oral language Environmental print awareness Conventions of print Experience with writing material Adult modeling ofliteracy activities Alphabetknowledge Targeted Clienteles The third set of analyses examined the clienteles for whom the activities were intended. The first analysis examined targeted age groups. More participants performed activities targeting preschoolers (81.0%) than kindergarteners (57.0%). Inspection of Table

62 42 II shows that more participants targeted preschoolers than kindergarteners regardless of the types of service delivery they provided. Table II: Percentage of Participants Using Each Type of Service Delivery to Target Clientele Groups Type of service delivery Information Coaching Stimulation Clientele (n 105) (n = 87) (n = 101) Preschoolers Kindergarteners Chiidren with symptoms Chiidren from the general population Chuidren from at-risk environments The second analysis examined targeted subgroups of children. Results showed that more SLPs targeted chiidren showing symptoms of future written language difficulties (82.6%) than those from the general population (69.4%) or at-risk environments (55.4%). Inspection of Table 2 also reveals a different distribution across the three types of service delivery. More participants using provision of information targeted children from the general population, compared to those targeting chiidren with symptoms or children from at-risk environments. More participants performing coaching targeted children with symptoms, than those from at-risk environments, or from the general population. More participants performing direct stimulation targeted children with symptoms, compared to those targeting children from the general population, or chiidren from at-risk environments.

63 Collaboration The last set of analyses examined the collaborative aspect of $LPs work in prevention of R&WD. Three quarters of the participants (74.4%) worked in collaboration. More participants worked with collaborators from the education system (44.6%) than with professionais from the health care system (34.7%) and with coïlaborators from outside the healthcare or educational systems (community organisations, day cares, preschools, and volunteers, 33.9%) Trainiiig Training in prevention of R&WD was examined through participants rating of their training and the sources of training they used. Half were satisfied with their training: 7.4% rated it as excellent and 38.9% as good. But half were flot completely satisfied: 31.5% rated it as fair and 22.1% as insufficient. More participants obtained their training in prevention of R&WD from continuing education (90.7% from workshops and conferences, personai reading and peer discussions) than from their training as SLPs (76.8% from initial university training, other university training and clinical training). 3.5 Discussion Given that only 151 SLPs participated to the study results of the current study may not be ftilly representative of the practices of ail Canadian SLPs. However, the results provided initial information conceming the scope of practice and the nature of the activities in prevention ofr&wd among the Canadian SLP$ who participated to the survey.

64 Scope of Practice in the Prevention of Reading and Writing Difficultïes The first goal of the present study was to obtain a preliminary measure of the extent of practices among Canadian $LPs in prevention of literacy difficulties. Although a large majority of the SLPs in the study engaged in prevention of R&WD, they devoted about 12% of their work time to it, equivalent to haif the time spent on prevention of oral language difficulties. These findings are consistent with those reported by Katz et al. (2006). In their preliminaiy survey, 70% of the 12 participants believed that literacy was within their scope of practice, and time was identffied as a barrier to provision of service. In the current study too, time could be a factor limiting prevention of R&WD efforts, given the heavy work Ioad that SLPs experience in Canada (Bakler, Chambers, Kaegi, Schneider, & $vitich, 2002; Lagace & Potter, 1995). A survey conducted by the Canadian Association of Speech-Language Pathologists and Audiologists (2003) revealed that many $LPs feei they are unable to provide an adequate level of service to clients due to excessive workload. However, given that it is easier to prevent than to treat written language problems ($now et al., 1998), prevention should nonetheless remain a priority for ail early childhood practitioners, including SLPs. Efficient ways exist to identify at-risk chiidren early on (Justice, Invernizzi, & Meier, 2002) and to offer efficient preventive services to them (Justice & Pullen, 2003). In the long run, better prevention may reduce the need for speech language pathology services Nature of the Activities in the Prevention of Reading and Writing Difficulties The second objective was to describe the nature of activities in the prevention of R&WD carried out by the $LPs who participated in the study. Types of service delivery, targeted emergent literacy components and clienteles, and collaboration were analysed.

65 45 Types of service delivery provided by the SLPs were diverse, as prescribed in the guidelines published by ASHA (200 la). Most ofthe SLPs offered indirect services, such as providing information for parents and early childhood practitioners, and direct services, such as providing stimulation with chiidren themselves. Slightly fewer provided coaching of parents or caregivers. Ail emergent literacy components were reported as targeted by the SLPs; joint-book reading, phonological awareness, and sense of story primarily, but oral language and other emergent literacy components were aiso addressed. These findings confirm that many SLPs generally treat most of the components recommended in the guidelines published by ASHA (2001 a), but tend to focus on emergent literacy components that are traditionaliy part of their field of expertise. This is consistent with the resuits of Coe Hammond et al. (2005) and Katz et al. (2006) who found that SLPs were more comfortable integrating the more traditional targets of speech-language pathoiogy like phonological awareness and vocabulary into their practices in reading and writing. It is important to highlight that alphabet knowledge and print conventions are two of the best predictors of reading and writing success (Hammiil, 2004; National Eariy Literacy Panel, 2004), aiong with phonological awareness and oral language abilities. Moreover, phonological awareness training is known to be effective if it is associated with letter-sound conespondence teaching (Giilon, 2004). Thus alphabet lmowledge and print conventions, although not identified as priorities in the current study, may nonetheless be important to include when phonological awareness training is undertaken by $LPs. Another unexpected finding was that the oral language component was not among those targeted most ftequently by the SLPs, although this is their main domain of expertise. Oral language components such as elaborated vocabulary, complex grammar, decontextualized discourse and inferential language are associated with reading and writing success (Dickinson & $now, 1987; Hammill, 2004; van Kleeck, 2006) and thus also need to be emphasized. However, the definition of the oral language component in the glossary exciuded oral language as treated

66 46 within the context of speech-language therapy sessions with chiidren showing oral language problems. The SLPs may focus on components they already treat in therapy with chiidren showing oral language difficulties, and may choose flot to overload their therapy by adding preventive goals in reading and writing to their curative goals in oral language. They may also be treating relevant language goals directly, which, based on the definition of prevention offered, would preclude them reporting such efforts as prevention of R&WD. Conceming the types of service delivery provided for prevention of R&WD, the SLPs tended to offer direct services for components like phonological awareness and sense of story, but indirect services for components like joint-book reading. The nature of each component suggests a possible explanation for this tendency: $LPs may play a more indirect role for emergent literacy components that lend themselves to implicit teaching, such as joint-book reading. They play a more direct role for more complex components that need explicit teaching, such as phonological awareness and sense of story. The clienteles targeted by a large proportion of the SLPs included preschoolers before they enter kindergarten and those showing symptoms of future written language difficulties. Kindergarteners, chiidren from the general population or those from at-risk environments were also targeted, but by a smaller proportion of the SLPs. These findings suggest that some SLPs are concemed about early preventive activities, especially for children most likely to develop reading and writing difficulties, as prescribed in the scientific publications and policies in the prevention of R&WD (Snow et al., 1998). Nevertheless, the chiidren from more vulnerable environments such as linguistic minorities or lower income families stiil represent a population at risk for later reading and writing underachievement (Snow et al., 1998; Willms, 1999). Given that a majority of these children tend to show problems in reading and writing development that are explainable by environmental factors (access to print material, limited language interaction, lack of adult models involving literacy), prevention could be very effective among this population (Torgesen, 2002) and reduce future reading and writing problems in school. Ail three types

67 47 of service delivery were used with similar proportions by the SLPs with both preschoolers and kindergarteners, but direct services were offered more for chiidren showing symptoms of future written language problems than for children from the general population or from vuinerable environments. Knowing that direct services resuit in a heavier workload than do indirect services, the SLPs seem to favour direct services for smaller groups such as children showing symptoms of future written language problems, where more specialised knowledge and competencies are required. Sharing responsibilities with others for larger population groups could thus constitute a strategy to increase efficacy in the context of a heavy workload. Indeed, collaboration was part of the practice of three quarters of the $LPs. These findings suggest that the SLPs follow ASHA recommendations (200 la) and consider collaboration an important element in shared responsibilities and roles regarding prevention of R&WD. In the present study, collaboration occurred primarily with other professionals from the same work setting. It is reasonable to think that it is easier to collaborate with other professionals working in the same organisation than to reach out for collaboration with people outside the health and the education systems Training in the Prevention of Reading and Writing Difficulties The third goal of the study was to explore the perception of these SLPs regarding their training in prevention of R&WD. The overall evaluation of training was divided and the SLPs actively sought out additional sources of information to improve on their initial training. This evaluation is not as positive as the one in Coe Hammond et al. s study (2005) in which SLPs feit fairly knowledgeable about literacy. The mitigated opinion about the training in the current study suggests that the participating SLPs feit that there is room for improvement in this regard. It may also provide additional explanation for the reduced work time dedicated to prevention of R&WD and the low priority given to important emergent literacy components such as alphabet knowledge and print conventions.

68 Limitations of the Current Study and Recommendations for Further Studies The fourth goal of the current study was to identify the modification needed to the current study in order to lay the foundations for a further detailed study. First, the sample of the current study may flot be representative of ail Canadian SLPs working with young chiidren. In order to provide a wider perspective in regards to prevention of R&WD, the use of an online survey generator may help reach more $LPS by making the survey faster to complete, without needing to print and fax forms as in the current study. One may also argue that SLPs who decided to participate might already have had an interest in the prevention of R&WD and may therefore have be more motivated to complete and retum the forms. Thus the results of the current study may have drawn a more positive picture of what is going on in the field than would be obtained with a iarger sample. If so, however, recommendations about the increase of work time and training devoted to prevention of iiteracy difficulties would not oniy stiil be appropriate, they would be even more essential. The analyses revealed that scope of practice, activities and training were parameters providing relevant information about SLPs practices in prevention of R&WD. The gap between the proportion of SLPs invoived in prevention and the proportion time spent on it captured an important feature of the scope of practice. Types of service delivery, targeted emergent literacy components and clienteles, and collaboration provided rich information about the nature of the activities, but the categories used were flot optimal. It would be more informative to classify types of service delivery into only two categories: direct and indirect services. There were also too many emergent Ïiteracy components; a classification using iarger categories would be more useful and would facilitate analysis (e.g. a print awareness category could include environmental print awareness, conventions of prints and alphabet knowiedge). In addition, the emergent literacy components included specific activities such as joint-book stories, adult modeling of literacy activities, and experience

69 49 with writing material that can be used to enhance emergent literacy skills like print awareness. It would also be easier to use the population subgroup categories directly (i.e., chiidren from the general population, children from at-risk environments, and chiidren with symptoms) instead of using the type of preventive measure (universal, selective, and indicated) to identify the targeted clientele. The collaborator categories would be more efficient if divided between those from the same work setting and those from outside the main work place. In addition, families as possible collaborators should be included, which was not the case in the current study. Regarding training, more information about the actual training received would be useful, not only about the perception of it. Sources of training could be simplified in two categories: initial training and continuing education. future studies should also address another important issue often associated with prevention: early identification of chiidren at risk for developing R&WD. The resuits of cunent study may underestimate some of the work done by SLPs in prevention of literacy difficulties because early identification was flot included. Given that the goal of the current study was not to provide a detailed and extended description, but rather an initial picture of the prevention of R&WD among Canadian SLPs, systematic validity or reliability analyses of the questionnaire were not performed, although pre-testing was carried out to ensure clarity of the questions and definitions, and user friendliness of the questionnaire. To ensure the soundness of the results of a more detailed inquiry, validity and reliability measures of the questionnaire would be mandatory. Finally, factors such as the facilities in which SLPs work and the graduation time may have had an influence on both the scope of the preventive practice and the nature of the activities in prevention of R&WD. These variables may need to be taken in account in future studies to provide a clearer portrait of preventive practices.

70 Conclusions Overail, the resuïts suggest that SLPs in Canada play a role in prevention of R&WD, but they dedicate a limited amount of time to it. Their activities in prevention of R&WD are generally in une with the recommendations of ASHA (200 la) and the Committee on the Prevention of Reading Difficulties in Young Chiidren (Snow et al., 1998). However, additional measures may be needed to encourage those SLPs to address some specific emergent literacy components such as alphabet knowledge and print conventions, and some at-risk sub groups of chiidren. One promising solution may be to better prepare future SLPs through initial university SLP training and provide continuing education to those already working with chiidren.

75 Appendix A: Text oftlie Survey If you work with 0-6 year-old preschool chiidren including those in kindergarten, you may participate in this study. Even if you don t work precisely in emergent literacy or in prevention of reading and writing difficulties, you may participate. We need answers from as many speech-language pathologists working with preschoolers as possible to capture a real picture of the situation. Even if you work only part time with preschoolers, you may participate. If you only work with children in lst grade or higher, adolescents, adults, or the elderly, you cannot participate. This survey takes only 10 minutes to fil out on your computer. Part 1: Demographic Information 1. In which year did you finish your university training in speech-language pathology? D < 1960, D , D , D , D , D In which language do you practice speech-language pathology? D English, D french, D other(s): 3. In which type of establishment do you practice speech-language pathology? D community health center, D hospital, D private practice, D rehabilitation center, D schools including kindergarten, D other(s): 4. In which province or area do you practice speech-language pathology? D Alberta, D British Columbia, D Manitoba, D New Brunswick, D Newfoundland and Labrador, D Northwest Territories, D Nova Scotia, D Nunavut, D Ontario, D Prince Edward Island, D Quebec, D Saskatchewan, D Yukon

77 O other(s): In general, do you work in collaboration with other preschool workers for prevention of written language difficulties? If yes, specify with whom. U no, U yes. U volunteers, U community organisations, O school staff, O health care staff, Part 3: Training 8. How would you qualify your training in prevention of reading and writing learning difficulties? O excellent, O good, O fair, C insufficient 9. What are your sources of training on this subject? (leave blank if you have none) D university training in speech-language pathology, O workshops and conferences, O clinical training, D personal readings, D other university training, D other(s):

78 Appendix B: Glossary Prevention in speech-ïanguage pathology can be described as: «The set of activities which prevent the emergence of oral and/or written language difficulties». It includes activities, prior to any evaluation or intervention plan, which aim to establish favourable conditions to support the maximal development of oral and/or written communication of chiidren. In preventive practice, activities include: ta) information for the public, parents, professional or preschool workers about the development and the stimulation of oral and/or written communication; (b) online coaching of parents or caregivers for providing the stimulation of oral and/or written communication; (c) early stimulation of oral andlor written communication directly with chiidren. Emergent literacy components: ta) Joint-book reading: sttategies to make reading interactive and rewarding for children, access to books if needed, motivation and pleasure of reading; (b) Environmental print awareness: recognition of logos, symbols, or signs; (c) Conventions of print: direction of reading, orientation of books, space in between words, punctuation; (d) Phonological awareness and sensitivity: rhymes, alliterations, phoneme and syllable games; (e) Alphabetic/letter knowledge: letters, numbers, frequent words, sorting words by letters; (f) $ense of story (narrative structure): logical and temporal sequence of events in narratives; (g) Aduit modeling of literacy activities: examples ofreal actions related to literacy and the daily use of writing; (h) Experience with writing materials: access to paper and pencils to scribble, copy and pretend to write; (j) Oral language: components linked with reading and writing which are flot within the context of oral speech-language therapy sessions. Age groups: (a) Preschool: includes children from O to 5 year old who are not yet attending kindergarten; (b) Kindergarten: includes 5 or 6 year-old chiidren attending kindergarten, but flot lst grade; (c) Both: includes both groups.

79 59 Types of preventive measures: ta) U for universal: activities accessible to the population at large; (b) S for selective: activities adapted for populations who may be vuinerable to written language development problems (e.g.: low socio-economical status families, multi-ethnic groups); (e) I for indicated: activities accessible to children with symptoms indicating predisposition to develop written language problems (e.g. : chiidren with language delays); (d) U/S, U/I, S/1, and U/S/I combinations for parallel activities in more than one type of preventive measures.

80 Author Note Pascal Lefebvre, Centre de recherche du CHU Ste-Justine, Université de Montréal, Montréal, Québec, Canada; Natacha Trudeau and Ann Sutton, École d orthophonie et d audiologie, Centre de recherche du CHU Ste-Justine, Université de Montréal, Montréal, Québec, Canada. This study was supported by funding by Université Lavai, the Canadian Child Health Clinician Scientist Program, Abitibi-Consolidated and Centre de recherche du CHU Ste-Justine. The authors thank the speech-language pathologist who responded to the survey, as well as CASLPA, and ail the provincial associations and professional colleges (OOAQ, CASLPO, OSLA, RAOFO, ACSLPA, MSHA, NLASLPA, BCASLPA, NBASLPA, SHANS, PEISHA, AQOA, YSLPAA, SASLPA, ANTSLPA). The first author is a CIHR Strategic Training Fellow in the Canadian Child Health Clinician $cientist Program (CCHCSP). This article is part of the doctoral thesis of the first author. Aspects of this work were presented at the annual convention of the American Speech-Language Hearing Association in November 2005, and published in fréquences, vol.18, no.4, May Correspondence concerning this article should be addressed to Pascal Lefebvre, Centre de recherche du CHU Ste-Justine, Centre de réadaptation Marie-Enfant, 5200 Bélanger Est, Montréal, Québec, Canada, HiT 1C9.

83 Abstract This study measured the effects of 2 shared storybook reading programs on skills considered to be predictors of reading achievement: vocabulary, print awareness, and phonological awareness. It also examined whether the gap in these skills often observed between social classes could be reduced when the programs are provided to low SES chiidren only. An experimental group (n = 10) and a confrol group (n = 13) of low SES preschoolers received respectively an experimental or a control program. Both programs used shared storybook reading sessions, 4 times a week, over a period of 10 weeks. The control program used evidence-based strategies that explicitly targeted language and print awareness. The experimental program added strategies that explicitly targeted phonological awareness. A high SES comparison group (n 12) received no specific intervention. Results indicated that the experimental program improved phonological awareness more effectively then the control program. The experimental program brought the performance of chiidren in low SES environments up to the level of that of chiidren from high SES environments in the oral language and emergent literacy measures. The strategies from the experimental program could be introduced in existing shared storybook reading activities in childcare centres.

84 Introduction Approximately one third of chiidren in North America experience reading underachievement in school (Perie, Grigg, & Donahue, 2005). This proportion is even higher among chiidren living in poverty. The gap in reading success between chiidren ftom lower and higher socioeconomic status (SES) families finds its source in the arnount and the quality of oral language and literacy-related interactions in their environments during preschool years (Dickinson & Snow, 1987). Given that the difficulties ofthe chiidren from Iow SES backgrounds are environment-related, prevention can be very valuable for these chiidren (Dickinson, McCabe & Clark-Chiarelli, 2004) Shared Storybook Reading Among the preventive activities available, shared storybook reading, the interaction that occurs between aduits and chiidren when they share a storybook (Ezeil & Jutice, 2005), has been widely used to promote oral language and emergent literacy in chiidren, including those from low SES families (e.g. Lonigan & Whitehurst, 1998; Whitehurst, Amold, Epstein, Angeli, & al., 1994). Studies show that shared storybook reading can effectively contribute to the prevention of reading failure (Bus, van IJzendoorn, & Pellegrini, 1995; Scarborough & Dobrich, 1994). In fact, shared storybook reading is an ideal context in which specific skills can be addressed. The most powerful targets for preventing reading and writing failure are believed to be oral language, print awareness, and phonological awareness (National Early Literacy Panel, 2004). Oral language abilities include vocabulary, inferential language, grammatical skills, and narrative abilities (Van Kleeck, 2006b). Print awareness refers to the functions, forms and conventions of print, including alphabet knowledge (Justice & Ezeil, 2001). Phonological awareness refers to the sensitivity to the sound units of language, such as syllables, rimes, and phonemes, and to the ability to manipulate these units (Gillon, 2004). In their review of evidence-based

85 65 approaches, Justice and Pullen (2003) reported that preventive activities, such as shared storybook reading, should target these skills simultaneously. Lonigan (2006) affirms that phonological awareness, print awareness and oral language remain modular in the emergent literacy period, that is, enhancement of one does not lead directly to improvement in the others. However, efficiency studies using a shared storybook reading context have mainly studied oral language and print awareness, often in isolation, and very few have addressed phonological awareness ($tadler & McEvoy, 2003). Shared storybook reading offers a high-quality prevention context because it is favourable to the implementation of an embedded-explicit approach (Justice & Kaderavek, 2004). This type of approach promotes the use of natural and meaningful interactions in which the aduit systematically and explicitly emphasizes language and emergent literacy skills. Thus, multiple sets of strategies, embedded in the shared reading context, can help the aduit to scaffold interactions with chuidren in order to enhance their skills. Use of these strategies usually implies that the adult interrupts the reading of the storyline in order to make explicit comments or prompts. Dialogic reading strategies (Whitehurst, Falco, Lonigan, Fischel, & al., 1988) have a positive impact on vocabulary and grammatical skills in chiidren (e.g. Amold & Whitehurst, 1994; Huebner & Meltzoff, 2005). These strategies include, among others, open-ended questions and expansion of children s responses in order to prompt the chiidren to actively engage in the story. Repetitive use of the same book with explicit word explanations embedded in the shared reading enhances vocabulary even more effectiveïy (e.g. Penno, Wilkinson, & Moore, 2000; Sénéchal, 1997). Specific commenting on story-grammar or decontextualized language also induces gains in narrative skills and inferential language (Hayward & Schneider, 2000; van Kleeck, 2006a). Print referencing strategies have been shown to be effective in improving print awareness skills (Justice & EzelI, 2004). These strategies explicitly focus children s attention towards the forms (e.g., alphabet letters), conventions (e.g., reading directionality), and functions (e.g., print represents speech) ofprint.

86 Phonological Awareness Strategies Embedded in a Shared Storybook Reading Context Shared storybook reading should also be a good context in which explicit phonological awareness strategies can be embedded, but few studies have addressed this possibility. Given that phonological awareness training programs have mainly adopted a structured and decontextualized approach, Richgels, Proremba & McGee (1996) proposed using storybook readihg as a more holistic and meaningful context for phonological awareness intervention. Ukrainetz - McFadden (199$) introduced the sound talk strategies where the aduit explicitly discusses and asks questions about sounds in the words during shared reading and writing activities. Ukrainetz, Cooney, Dyer, Kysar, & Harris (2000) concluded that these strategies can improve phonological awareness in preschoolers. Ezeli & Justice (2005) and Hammett Price & Young Rusher (2006) also developed detailed embedded-explicit approaches to target phonological awareness at the level of syllable, rhyme, and phoneme through shared storybook reading activities. However, few empirical studies have been published to verify the efficacy of these approaches. Skibbe, Behnke, & Justice (2004) and Justice, Kaderavek, Bowies, & Grimm (2005) found that parent implemented phonological awareness intervention embedded in shared storybook reading can promote phonological awareness development of chiidren with language impairment. Williams (2006) proposed the Enhanced Dialogic Reading approach in which the aduit explicitly talks about oral language, print awareness, and phonological awareness during shared storybook reading activities. A program designed to train parents of preschoolers with this approach showed progress in phonological awareness, print awareness, and oral language skills in the chiidren (Davis, 2004). There is a need for prevention of reading and writing difficulties especially among 10w SES preschoolers. Shared storybook reading is an ideal context within which the aduit can use strategies that address oral language and print awareness. In order to maximise the

87 67 likelihood of future reading and writing achievement, phonological awareness skills should also be addressed. However, there is limited empirical evidence to support that skills in these three sets of skills can be enhanced simultaneously. further, most of the studies in phonological awareness training occurred in controlled conditions that may differ widely from real educational seffings such as shared storybook reading contexts (Troia, 1999). The present study was designed to explore the use of a shared storybook reading context to enhance language, print awareness and phonological awareness in at-risk preschoolers. Two research questions were addressed: (a) What are the relative effects of two shared storybook reading programs, one using strategies targeting oral language and print awareness and the other using strategies targeting oral language, print awareness, and phonological awareness, on three language and emergent literacy skills known as good predictors of reading and writing achievement?; and (b) Does the perfonnance of at risk children following intervention approach that of chiidren ftom high SES environments who have flot received intervention? 4.3 Methods Study Design A three-group pretest - posttest research design including an experimental group, a control group and a comparison group was used. Low SES chiidren were recruited ftom four different childcare centers. Two sites were randomly assigned to the control and two others to the experimental group. The control group received a shared storybook reading program using evidence-based strategies targeting oral language and print awareness skills. The experimental group received an enhanced shared storybook in which time dedicated to strategies targeting oral language and print awareness was reduced in order to include strategies targeting phonological awareness also. Higher SES children from three other

88 68 childcare centers were assigned to the comparison group without any intervention. The study took place in childcare center settings to increase its extemal validity Participants The chiidren were recruited from pubiicly subsidized childcare centers in Québec City, Québec, Canada. The criteria for ail chiidren were French as the native language (i.e. exposed to French 90% of the time or more), normal hearing and cognitive development, and reading flot yet acquired. Additional criteria for higher SES chiidren were normal language development according to parents and educators reports, not having received speech-language pathology services, and family income above Statistics Canadas low income cut-offs (Statistics Canada, 2006). Theses cut-offs take into account the annual family income before taxes, the size of the family unit and the size of area of residence. An additionai criterion for lower SES participants was family income below Statistics Canadas iow-income cut-offs. Chiidren from this group were not excluded if they received speech language pathology services or if they showed language delay according to their parents or educator, given the high prevalence of language delay in the low SES population (Dickinson & Snow, 1987) and that language delay is a risk factor for future reading and writing failure (Catts, Fey, Zhang, & Tomblin, 1999). Forty-two selected participants were screened for hearing status, cognitive skills, and receptive vocabulary. Hearing screening was performed using a MaicoTM MA 27 portable audiometer and a GSI 37 Auto TympTM tympanometer. The pass criterion was detection of 500, 1000, 2000, and 4000 Hz tones at 25 db HL in at least one ear, in conditioned play audiometry screening under conventional earphones. However, given that iow frequency tones are harder to detect in presence of background noise, if the pure tone at 500 Hz was not detected at 25 db HL, tympanometry resuits had to be within normal range for ear canai volume (between 0.4 and 1.0 cm3), pressure peak (between -150 and 100 dapa), compliance peak (between 0.2 and 0.9 cm3) and gradient (between 60 and 50 dapa).

89 69 Cognitive skills were screened using the Leiter International Performance Scale-Revised (LIPS-R) (Roid & Miller, 1997), a non-verbal battery. Receptive vocabulary screening was performed using the Échelle de vocabulaire en images Peabody (ÉVIP) (Dunn, Thériauit-Whalen, & Dunn, 1993). Two chiidren did flot pass the hearing screening test and their parents were met by the first author for a reference in audiology services. Thus, 40 chiidren participated in the study: 12 were in the higher SES group and 28 were in the lower SES groups. Five low SES chiidren, 3 from the experimental group and 2 from the control group, were excluded from the data analysis because they did not complete at least 50% of the shared storybook reading program. The program participation rate was calculated by dividing the number of minutes of child presence by the number of minutes of intervention. The mean participation rate of the remaining 23 chiidren was equivaient in the experimental and control groups: 85.3% (SD = 10.2) for the experimentai group and 85.7% (SD = 9.2) for the control group, t(21) = O.ll,p =.92. Table I shows the characteristics of the participants in each study group. In order to determine whether the groups were similar prior to implementing the procedures, several statistical comparisons were made. There were no differences among the groups in age, F(2,32) = O.O4,p =.96, nor in sex distribution, 2(2, N= 35) = O.03,p =.99. Differences among the groups were identffied in child vocabulary scores, H(2) = 8.l4,p =.02, annual family income H(2) = 22.94,p <.01, and parent education, H(2) = l8.o4,p <.01. Multiple comparisons with alpha level set at.017 revealed that the comparison group s resuits were higher than those of the experimental and the control groups on the three measures (ail ps <.01) except for vocabulary between the control and the comparison groups (p =.03). finaliy, no difference was found in the distribution of chiidren with language delay between the experimental and the control groups, 2(1, N= 23) = OA3,p =.51.

90 70 Table I: Characteristics ofthe Participants Group Experimental Control Comparison Variables (n=10) (n=13) (n=12) Gender Number of males Number of females Number with language delay Mean age in months (SD) 57.1 (4.3) 57.5 (3.6) 57.5 (2.9) Mean vocabulary ($D) 99.5 (14.3) (18.5) (10.3) Mean annual income in $ (SD) (12463) (8514) (56877) Mean parent education (SD)b 0.7 (0.9) 0.7 (0.8) 2.4 (0.7) Standard score on the ÉVIP. b O = high school non completed; 1 = high school completed; 2 = college completed; 3 = university degree completed. For descriptive purposes, one parent or legal guardian of each child in the study was met by the first author for an assessment of family language and literacy exposure. One parent from the control group could flot be met for this assessment. The ÉVIP (Dunn et al., 1993) was administered to the parent or guardian as a measure of family language exposure. Then a family literacy questionnaire, a French adaptation of the questionnaire used by Sénéchal, Lefevre, Thomas and Daley (1998), was completed in order to gather information about home literacy experiences. In addition, an assessment of the language and literacy exposure was performed in each selected childcare center using the Early Language and Literacy Classroom Observation (ELLCO) (Smith, Dickinson, & Sangeorge, 2002). Table II shows the language and literacy exposure variables in cadi group. No difference among the three groups was found in frequency of parent reading of

92 72 Overail, these descriptive data confirm that the characteristics and the home language and literacy exposure of the experimental and the control groups were equivalent. The only difference was related to the childcare language and iiteracy exposure. These data also confirm that chiidren in the experimental and the control groups came from more at risk familles according to their SES characteristics and their language and literacy exposure, than those in the comparison group Materials To measure language and emergent literacy skills among the participating chiidren, criterion-referenced instruments were chosen because they are more appropriate for monitoring progress in specific areas than are norm-referenced tests (McCauiey & Swisher, 1984). Ail the criterion-referenced instruments used in the current study are availabie from the first author Vocabulary Measure A receptive vocabulary instrument was deveioped to measure the knowledge of 15 vocabulary words targeted by the programs (see Appendix), similar to those developed in other studies on vocabulary acquisition from stoiybooks (e.g. Robbins & Ehri, 1994; Sénéchal, 1997). For each word, the chiidren were asked to point to its corresponding picture among four different black and white pictures presented on a page. The picture of the target item included in the vocabulary test was different from the one in the storybooks. The three other pictures iliustrated a word from the same grammatical category as the target item (noun, verb or adjective) and with the same frequency of occurrence in children s school books according to NOVLEX (Lambert & Chesnet, 2001), a French lexical database. The whole instrument inciuded 3 practice items, 15 items related to the target vocabulary words, and 10 other easy high frequency items (e.g. apple, truck) to maintain motivation during the assessment. The order of the items in the instrument was randomly

93 73 assigned. Each item was worth 1 point, for a maximum of 25 points. Given that ail chiidren correctly identified the 10 easy items as expected, the global score was used in the analyses because the differences in scores were due only to the rare items Print awareness Measure A French adaptation of the Preschool Word and Print Awareness (PWPA) protocol (Justice & Ezeil, 2001), deveïoped with the authorisation of the authors, was used as a measure of print awareness. The PWPA uses an adult - child shared storybook reading interaction with the picture book Nine Ducks Nine (Hayes, 1990). During the interaction, the examiner asks questions about 14 concepts about print. Each answer is worth 1 or 2 points for a maximum of 17 points Phonological Awareness Measure The Épreuve préscolaire de conscience phonologique (ÉPCP) (Lefebvre, Girard, Desrosiers, Trudeau, & Sutton, 2007) was used to measure phonological awareness. These french tasks were derived from those used by Courcy, Béland and Pitchford (2000) and by Lonigan, Burgess, Anthony, & Barker (1998). The tasks were selected to be developmentally appropriate for 4- to 5 year-olds according to the data available in french and in English (Duncan, Colé, Seymour, & Magnan, 2006; Lecoqc, 1991; Lonigan et al., 1998). The instrument includes four tasks: rhyme judgement, initial consonant comparison, syllable segmentation, and syllable deletion. To control for possible lexical and semantic biases, the measure uses non-words controlled for their length, syllabic structure and type of phoneme. The linguistic complexity of the stimuli is controlled so that complexity increases within each task according to the sequence proposed by Chafouleas & Martens (2002). Each task includes 2 training items, 4 practice items and 10 assessment items, a number sufficient to be sensitive to intervention effects (Chafouleas & Martens, 2002). The instrument also includes manipulation of wooden blocks to make the task more concrete (e.g. separation of two blocks to illustrate syllable segmentation). The first two tasks

94 74 require a yes/no response and the last two require children s oral production. Each answer is worth Ï point for a maximum of 40 points Procedures Shared Storybook Reading Programs The control group received a shared storybook reading program using strategies targeting inferential language skills, vocabulaiy and print awareness. Specffic commenting was used to target five inferential language skills: inference on characters feelings, connection to child s life, explanation, problem resolution, and prediction. Each of the inferential language skills was taught during four sessions per week over a period of 4 weeks. The vocabulary words targeted in the program (see Appendix) were selected according to their rarity. five nouns, adjectives or verbs perceived as infrequent were chosen in each book by the first author. Their frequency of occurrence in chiidren s school books was verffied using two french lexical databases: NOVLEX (Lambert & Chesnet, 2001) and MANULEX (Lété, $prenger-charolles, & Colé, 2004). Only words with an occurrence lower than 100 per million words in children s school books in both databases were retained. Three of these words in each book were used for assessment according to their capacity to be illustrated. Each of the 15 selected words was taught four sessions a week, for a period of 2 weeks. They were explained in many ways as proposed in the literature (Ezeli & Justice, 2005; Hindman & Wasik, 2006): providing a definition and a synonym, showing the concept on the illustration or in the room, miming, and generalizing the new word in another context. Also, the experimenter added explanations by using the children s background experience related to the new word that was taught. Ten print awareness concepts chosen from the literature (Ezell & Justice, 2005; Justice & Ezeil, 2004) were explicitly and systematically taught in each program through

95 75 the print referencing strategy: book cover, book titie, print and picture differentiation, onset of reading, print directionality, author and illustrator, dialogue marks, wriften language units (letter, sentence and paragraph), uppercase and lowercase differentiation, and letters of the alphabet. Each of the ten print awareness concepts was taught during four sessions a week over a period of 3 weeks. The experimental group received an enhanced shared storybook reading program using strategies targeting phonological awareness as well as oral language and print awareness. The strategies used to target oral language and print awareness were the same as in the program that the control group was provided with, but less time was dedicated to them in order to add strategies targeting phonological awareness. The phonological awareness strategies were initiated by embedding non-words into the reading of the storybook. Non-words were used to bypass children s natural focus on the meaning of the words rather than on their form (van Kleeck, 1995). The children were asked to flag each of three non-words in the adult s reading. Each non-word was then written on a piece of paper to provide a concrete visual cue for phonological manipulations (e.g. tearing the word in two parts for syllable segmentation). The alphabetic principle (the letters in words match the sounds of words) was overtly demonstrated in that way, making the phonological awareness training more powerful (Bus & van IJzendoom, 1999). Ten phonological skills, developmentally appropriate for preschoolers according to the current literature (Duncan et al., 2006; Lecoqc 1991; Lonigan et al., 1998), were then taught in this order: non-word identification, syllable segmentation, syllable blending, rhyme judgement and oddity, initial and final syllable deletion, syllable inversion, initial consonant comparison and oddity. Each of the phonological awareness skills was taught in three sessions over a one week period. As linguistic characteristics of the stimuli can influence performance on phonological awareness tasks (Chafouleas, VanAuken, & Dunham, 2001), the non-words increased in linguistic complexity during the sessions: two-syllable words with simple syllabic structure (e.g.: /pami/) in the beginning of the week and two- or three-syllable words with more complex syllabic structure (e.g.: /kuldas/) at the end of the week. The non-

96 76 words used with the experimental group were different from those used in the pretest and posttest measures of phonological awareness. Given that only the experimental group was exposed to phonological awareness strategies, less time was spent in the experimental group than in the control group on language and print awareness skills. The vocabulary strategy consisting of linking the new word with the children s background knowledge was not used in the experimental group, and in the control group, the occurrence of the strategies targeting print awareness and inferential language skill was doubled in the sessions where the experimental group had print awareness strategies. Experimental and control groups received four shared storybook reading sessions a week during 10 weeks. Each session lasted from 20 to 30 minutes. Both programs used the same five storybooks in the same order (see Appendix). These books were chosen by the first author according to the following criteria: length of approximately 25 to 35 pages, large and clear illustrations, few sentences on each page, use of dialogue marks, and a repetitive story plot. The shared storybook reading sessions included flot only the chiidren participating to the study, but also the others from their childcare center group. Therefore, reading sessions were provided to groups of seven to nine children Treatment fidelity Session length in the 4 childcare centers was very similar. In the 2 childcare centers in the control condition, mean session lengths (SD) were 24.5 minutes (2.5) and 24.1 minutes (3.2). In the 2 childcare centers in the experimental condition, they were 24.9 minutes (3.3) and 25.5 minutes (3.0). There was no difference among the four groups, F(3, 156) 1.53,p =.21. Thirty of the 160 sessions were randomly selected and videotaped for analysis. An independent examiner, blind to the interventions, coded the videos, using a checklist identifying the occurrence of adult strategies targeting oral language and emergent literacy skills. A 95% treatment compliance rate was found in each given program, compared to the

97 77 theoretical programs described in the previous section. As expected, the experimenter dedicated a larger proportion of his behaviors in the control program than in the experimental program to target oral language and print awareness skiïls, because he spent time on phonological awareness in the experimental program only. However, no difference was found in the distribution of behaviors across target categories when behaviors targeting phonological awareness were removed from the analysis in the experimental group. Overaïl, these analyses revealed excellent treatment fidelity. More details about the treatment fidelity procedure are available from the first author Assessments Three criterion-referenced instruments examining vocabulary, print awareness and phonological awareness were administered to ail chiidren 2 to 3 weeks before the intervention and within 2 to 3 weeks afler the completion of the programs. The pretest assessments were performed by the first author and trained graduate students. The posttests were administered by a trained graduate student who was blind to intervention for the low SES children, and by the first author for the high SES chiidren. The 30- to 40-minute assessment sessions took place in the childcare centers, in a separate room where visual and auditoiy distracters were reduced. The examiners filled out the response forms on site. The phonological awareness assessments were recorded on audiotape for inter-rater reliability measures. Four research assistants, blind to the intervention, listened to the children s oral production in the syllabic segmentation and syllable elision tasks from 17% of the phonological awareness assessments that were selected randomly. They had a 96% agreement with the examiners recording of children s production. However, the remaining 4% disagreement on children s production did not change the individual scores because the two answers were attributed the same score according to the pass criteria for the items.

98 Analyses First, one-way ANOVAs with an alpha level of.05 were used to compare pre- and posttest scores between groups. Post hoc comparisons were performed with the Least Significant Difference (LSD) procedure. Second, a series of paired t-tests with alpha set at.05 was used to verify if the chiidren within each group had significantly higher posttest scores compared to pretest scores. Third, the relative improvement in oral language and emergent literacy scores in each group was calculated by subtracting the pretest scores from the posttest scores. One-way ANOVAs with an alpha level of.05 were used to compare the improvements among groups. Post hoc comparisons were then performed using the LSD procedure. 4.4 Resuits Figure 1 illustrates the progress made by all groups on oral language and emergent literacy scores. Before intervention, a significant difference was found among the groups on vocabulary, F(2, 32) = 9.14,p <.01, and print awareness, f(2, 32) = $.Ol,p <.01, but flot on phonological awareness (M= 15.2, 3D 5.9 for the experimental group, M= 13.9, 3D 7.8 for the control group, and M = 19.0, 3D = 7.5 for the comparison group), F(2, 32) = 1.69,p.20. Post hoc comparisons revealed that pretest vocabulary scores were higher for the comparison (M= 18.3, 3D = 2.3) group than for the experimental group (M= 14.0, 3D = 2.2) (p <.01), and the control group (M= 16.2, 3D = 2.4) (p =.04). Pretest vocabulary scores were also higher for the control than for the experimental group (p =.03). Pretest print awareness scores were higher for the comparison group (M= 9.6, 3D 3.2) than for the experimental (M= 6.5, 3D = 2.8) (p =.02), and the control group (M= 5.1, 3D = 2.5) (p <.01).

101 81 vocabulary improvement was greater in the experimental group (M = 8.6, 3D = 1.4) than in the control group (M= 6.4, 3D = 2.0) (p 0.01), and the comparison group (M= 1.5, 3D = 2.4) (p <.01), and also greater in the control group than in the comparison group (p <.01). Print awareness improvement was greater in the experimental (M 8.5, 3D = 2.5) (p <.0 1), and in the control group (M= 9.3, 3D 2.8) (p <.01) than in the comparison group (M 2.17, 3D 3.8). Phonological awareness improvement was greater for the experimental group (M 14.3, 3D = 5.0) than for the control (M = 3.9, 3D = 6.4) (p <.01), and the comparison groups (M= 3.8, 3D = 7.2) (p <.01). 4.5 Discussion This study addressed two gaps in the literature. first, it showed that shared storybook reading programs can provide gains in oral language and emergent literacy skills in natural educational settings such as childcare centers. It also provided evidence that explicit strategies embedded in shared storybook reading contexts can enhance flot oniy vocabulary and print awareness, but also phonological awareness Effects of the Two Shared Storybook Reading Programs Both programs resulted in significant increases in vocabulary, print awareness and phonological awareness scores. Given that mean improvement for both vocabulary and phonological awareness was significantly higher for the experimental than for the control group, it would be tempting to conclude that the experimental program had a greater impact on both vocabulary and phonological awareness than did the control program. However, the effect size was larger in the experimental program than in the control program for phonological awareness, but not for vocabuïary. Also, chiidren in the experimental program started with significantly lower scores on the vocabulary measure than did those in the control program. This might be related to the fact that the control group benefited from greater language and literacy exposure in their childcare center than the experimental group

102 82 as observed with the ELLCO (Smith, Dickinson, & Sangeorge, 2002). In addition, both groups reached ceiling on the vocabulary measure. Thus, it would be premature to conclude that the experimental program was really more efficient that the control program in increasing vocabulary. Nevertheless, the experimental program is stili more efficient because it not only improves vocabulary and print awareness as much as the control program, but it also increases phonological awareness more efficiently. The posttest resuits confirmed the superiority of the experimental program over the control one because the experimental group scored higher only in phonological awareness measures. Thus, spending less time on strategies targeting vocabulary and print awareness in order to focus also on those targeting phonological awareness gives added value to shared storybook reading sessions. The findings are consistent with those of previous studies. The very large effect sizes found for the skills that were explicitly taught in either group, parallel to the large effect found for phonemic awareness in the chiidren with initial low-achievement in emergent literacy skills (d = 0.91) in Ukrainetz et al. s (2000) study. This study used the sound talk strategy in shared reading and writing activities. The findings are also consistent with Davis (2004) study on enhanced dialogic reading, in which the skills that had been explicitly encouraged improved significantly. The effect size for phonological awareness improvement in the more holistic context of the enhanced shared storybook reading program even exceeded the one found by Bus & van IJzendoom (1999) (d = 0.73) in their meta-analysis of 70 studies of decontextualized and structured phonological awareness training published between 1973 and These findings support the notion that explicit phonological awareness training can produce at least equally large effects in a natural context such as shared storybook reading, as it does in highly structured programs. They also support the proposal that oral language and emergent literacy skills remain modular (Lonigan, 2006) because each skill needed to be addressed explicitly to produce greater gain.

103 83 Despite the fact that the intervention took place with several chiidren at a time, a large effect size was found for vocabulary, print awareness and phonological awareness for the chiidren receiving the experimental program. However, Huebner (2006) reported that effect size of gain in language skills decreased dramatically even in a group oftwo chiidren compared to a one-on-one interaction in dialogic reading studies. Several factors could explain this discrepancy. Repeated reading in the programs may have maximized the effects compared to dialogic reading in which repeated use of a same book is not mandatory. In addition, the criterion-referenced measures used in the current study may have been more sensitive to growth in the targeted skills than the norm-referenced tests often used in dialogic reading efficacy studies. Finally, in regards to phonological awareness training, the use of non-words may have accelerated the gains compared to other phonological training programs that mainly use real words Oral Language and Emergent Literacy Sidils in Two Socio Economic Classes Before the intervention, the chiidren in the experimental group showed lower scores than chiidren from the comparison (high SES) group on vocabulary and print awareness, but not on phonological awareness. These resuits partly confirm that lower SES chiidren show lower oral language and emergent literacy skills than their higher SES peers before entering kindergarten (Dickinson & Snow, 1987). Bowey (1995) even found differences between lower and higher SES preschoolers specifically in phonological awareness, in contrast to the resuits of the current study. Given that phonological awareness develops more effectively when it is explicitly addressed by aduits, it may be that the high SES chiidren in the current study had neyer been exposed to explicit comments about language sound structures, whether at home, or at their childcare centers. Also, inter-individual variability was greater for phonological awareness scores than for the other measures. Given that the pretest mean score of the comparison group was higher than those of the

104 $4 experimental and control groups, larger samples might show statistically significant differences. However, after the experimental program, ail emergent literacy scores of the experimental group exceeded those of the comparison group. These resuits tend to confirm that the experimental program can contribute to bring the performance of chiidren in low SES environments up to the level of that of chiidren from high SES environments. Given the restricted range of skills measured by the criterion-referenced tests used, especially in vocabulary where a clear teach to the test effect was observed, we can not generalize the resuits to broader skills like receptive and expressive vocabulary as measured by norm referenced tests. However, Vellutino & Scanion (2002) stiil advocate for prevention among chiidren who enter school with weaker oral language and emergent literacy skills. They found that intervention significantly reduces the prevalence of chiidren experiencing reading and writing difficulties in school oniy if it is provided early and intensively, and is adapted to children s individuai strengths and weaknesses. Enhanced shared stoiybook reading strategies are then good candidates to meet these requirements Clinical Implications The experimental program used embedded-explicit strategies to enhance oral language and emergent literacy skills that contribute the most to reading achievement in school. More specifically, the enhanced shared storybook reading program used non-words to perform phonological awareness tasks. Using non-words also showed secondary benefits during the program. First, asking the children to flag non-words embedded in the storyline prompted them to signal when they did not understand a word. In fact, the chiidren in the experimentai program raised their hand when they heard a word or an expression they did flot know, thinking that they were non-words. Thus, embedding non-words in the reading sessions may also be useful to identify words that are unfamiliar that may be appropriate intervention targets. This strategy also incidentally kept the chuidren motivated to listen

105 $5 carefiuly to the whole story because they had to maintain their attention in order to identify the non-words embedded in the reading. In this way, the high frequency ofrepeated reading was more acceptable in the experimental group. The first author noticed that chiidren in the control group tended to make negative comments about the length of the reading sessions ami the repeated use ofthe same book, but flot in the experimental group. It is reasonable to suggest that the strategies targeting phonological awareness could be introduced in existing shared storybook reading activities in childcare centers in addition to print referencing, specific commenting on inferential language skills, and extended vocabulary explanations. This enhanced shared stoiybook reading approach does not require any specific material other than storybooks adapted to the children s level, pieces of paper and a pen. However, training of the educators will be needed because they may flot spontaneously use many of these techniques in their own shared storybook reading activities (Girolametto, Weitzman, Lefebvre, & Greenberg, 2007) Limitations of the Study Given that the programs were delivered by a qualified speech-language pathologist, efficiency studies are also needed to verify if the same resuits can be obtained when the enhanced shared storybook reading activities are provided by educators in childcare centers. Further, the quantitative measures gathered in the current study may not be fully representative of children s performance on emergent literacy tasks in natural contexts. For example, the chiidren may succeed on phonological awareness tasks with non-words, but flot with real words. Adding natural observations would provide more compelling evidence of the experimental program s efficacy. In addition, the impact on other language skills such as inferential language that contribute to reading and writing acquisition has not been fully investigated. The only objective oral language measure in this study targeted receptive vocabulary. A more comprehensive assessment of oral language skills would be usefril in future studies. A follow-up study of these participants is also needed to verify whether

106 $6 gains in emergent literacy from the shared stoiybook reading sessions are maintained over time and lead to reading and writing success in school. As the resuits of the current study are only applicable for french-speaking preschoolers with no cognitive or hearing deficits, research in other languages and with other at-risk populations is needed Conclusions The enhanced shared storybook reading program used in this study was found to be more effective in increasing vocabulary, print awareness and phonological awareness simultaneousïy than was a shared storybook reading program that explicitly targets oral language abilities and print awareness only. The enhanced shared storybook reading program also contributed to bringing the performance of low SES children up to the level of that of high SES children in these specific oral language and emergent literacy skills. The overali results support the idea that explicit strategies embedded in shared storybook reading contexts can be used as a preventive activity to help at-risk preschoolers better prepare for formai instruction in reading and writing in school. This approach could eventually contribute to reduce reading failure in schools if it is used intensively, and early on in the child s developmental pathway.

115 Author Note Pascal Lefebvre, Centre de recherche du CHU Ste-Justine, Université de Montréal, Montréal, Québec, Canada; Natacha Trudeau and Ann Sutton, École d orthophonie et d audiologie, Centre de recherche du CHU $te-justine, Université de Montréal, Montréal, Québec, Canada. This study was supported by funding by Université Lavai, Canadian Child Health Clinician Scientist Program, Abitibi-Consolidated and Centre de recherche du CHU Ste Justine. We would like to thank ah the chiidren, the families, the childcare centers, and the students at Université Laval who participated in the study. The first author is a CIHR Strategic Training Fellow in the Canadian Child Health Clinician Scientist Program (CCHCSP). This article is part of the doctoral thesis of the first author. Aspects of this work were presented at the annual convention of the American Speech-Language-Hearing Association in November 2005 and at the annual symposium of the Canadian Chiid Health Ciinician-Scientists Program in October Correspondence conceming this article should be addressed to Pascal Lefebvre, Centre de recherche du CHU Ste-Justine, Centre de réadaptation Marie-Enfant, 5200 Bélanger Est, Montréal, Québec, Canada, HiT 1C9.

118 Abstract This study examined the sensitivity and the psychometric properties of phonological awareness tasks designed for french-speaking preschoolers. In Experiment 1, a cross sectional design showed that a combination of 7 phonological awareness tasks was sensitive to developmental differences in phonological awareness between 4 and 5 years olds, but was too difficuit for 3 year-olds. Four of the initial tasks (rhyme judgment, initial consonant categorization, syllable segmentation, and syllable deletion) were then selected to form the Épreuve préscolaire de conscience phonologique (ÉPCP). In Experiment 2, pretest-posttest design including a control and an experimental group showed that the ÉPCP can effectively measure phonological awareness gains due to intervention in 4- to 5- year-olds. Both experiments provided good intemal consistency and concurrent validity measures for the instrument. The ÉPCP has the potential to become a useful tool for researchers and clinicians working with French-speaking preschoolers in the area of emergent literacy.

119 Introduction Phonological awareness refers to the sensitivity to the sound units of language, such as syllables, rimes, and phonemes, and to the abiiity to manipulate them (Gillon, 2004). It is one of the best predictors of reading achievement in the early school years (National Early Literacy Panel, 2004). Training chiidren to improve their phonological awareness allows them to acquire word recognition skills more easily (e.g. Bali & Biachman, 1988). In order to evaluate the efficacy of phonological awareness training programs and activities, researchers and practitioners in early childhood need valid and reliable assessment instruments that can measure gain accurateiy in young chiidren. However, existing assessment instruments ofien lack sensitivity to phonological awareness growth (Troia, 1999), and many of them are not adapted to young children before they enter kindergarten. In addition, few instruments are availabie in languages other than Engiish. The purpose of this article, therefore, is to explore the sensitivity, validity, and reliability of phonologicai awareness tasks designed for french-speaking preschooiers Phonological Awareness Assessment Methods Criterion-referenced tests are more appropriate than norm-referenced measurements for assessing the impact of an intervention on phonological awareness skills that are considered as critical for a population group (Sodoro, Allinder, & Rankin-Erickson, 2002). They generaiiy include sets of items that address different phonological awareness skills and they can be quickly administered. The psychometric properties of criterion-referenced experimental tasks are rarely documented, given that they are not standardized (Salvia & Ysseldyke, 1998). However, psychometric features such as internai consistency as measured by the Cronbach Alpha (a) coefficient, intercorrelations among tasks to ensure that they ail tap into the same underlying construct, and the concurrent validity as measured by the correlation with

120 100 another test reputed to be valid (Anastasi, 1988) can provide information on the qualities of the tasks. In order to be valid and provide good psychometric properties, the design of a phonological awareness criterion-referenced test must be based on solid theoretical background about the language in which it is developed, phonological awareness development in chiidren, the properties of specific tasks, and the linguistic factors associated with the stimuli used in tasks Linguistic Differences Between Frencli and Englïsh Most of the research concerning phonological awareness has focused on English and cannot be directly applied to French. french is a syllable-timed language whereas English is a stressed-timed language (Abercrombie, 1967). Further, most ofthe syllables in French display an open structure with the consonant vowel pattem while English has a greater proportion of syllables with a closed structure showing a consonant-vowel consonant pattem (Delattre, 1966). French is mainly polysyllabic, having a small proportion of monosyllabic words, while English has a higher proportion of monosysliabic words (Sprenger-Charolles & Colé, 2006). The stress pattem in words that are polysyllabic words is often different between the two languages: in french, stress remains constantly on the last syllable creating a weak-strong pattem, while, in English, stress position is variable with a greater preponderance of the strong-weak pallem (Delattre, 1966). The syllabic nature of the French language and its greater proportion of open syllabic structure, of multisyllabic words, and of weak-strong stress pattem may therefore directly influence the stimuli used in phonological awareness tasks designed for french-speaking chiidren Development of Phonological Awareness in French-Speaking Chiidren Knowledge about the development of phonological awareness provides information that can guide the design of phonological awareness tasks to make them developmentally

121 101 appropriate (Gillon, 2004). Many authors who have studied English-speaking children propose that phonological awareness development follows a universal sequence in which awareness of larger units appears prior to awareness of smaller units in words (e.g. Treiman & Zukowski, 1996). However, Gombert (1992), who conducted research with French chiidren, proposed that phonological awareness development is an environmentally-driven process influenced by the phonotactics of the language and the reading instruction provided to chiidren. A study conducted by Duncan, Colé, Seymour, and Magnan (2006) supports this theory by showing that phonological awareness development in English-speaking and French-speaking chiidren from 4 to 6 years of age followed distinctive steps, and that both sequences differered from the previously proposed universal large-to-small unit sequence. Most of the studies in French recognized that the syllable level was clearly more accessible for phonological awareness tasks prior to reading instruction and that phoneme and rhyme awareness emerged with reading and writing instruction (e.g. Bruck, Genesee, & Caravolas, 1997; Courcy, Béland, & Pitchford, 2000). The precocity of syllable awareness in french speaking preschoolers is thus important to take into account when choosing phonological awareness tasks for this age group. However, in his longitudinal study with French-speaking chiidren, Lecocq (1991) found that sensitivity to rhymes and initial phonemes emerged at 4 years of age, before sensitivity to syllables. Gombert s (1992) distinction between epilinguistic and metalinguistic stages of awareness could explain these contradictory resuits. Epilinguistic behaviors in children, like sensitivity to nursery rhymes, self-correction of speech and syllable tapping, are characterized as requiring only a low level of understanding, by a lack of intentionality and by a rich context embedding. Metalinguistic behaviors, in contrast, appear later under environmental influences, are often in more decontextualized tasks, and require conscious metacognition to tackle simultaneously the meaning and the sound structure of the words. Stanovich (1987) proposes a developmental continuum in which chuidren move from a shallower (epilinguistic) to a deeper level of sensitivity (metalinguistic) to speech sound units. Thus, Lecocq s phonological awareness

122 102 categorization tasks involving rimes and initial phonemes seemed to tackie a shallower level of phonological awareness than do his tasks involving manipulation of syllables. In fact, categorization is a forced choice task in which the child is asked to decide if specific sound segments in words are the same or flot. Manipulation tasks require the child to make a cognitive operation such as deleting or moving of a specific sound segment. In preschoolers, therefore, categorization tasks requiring a shallower level of phonological awareness would be appropriate to capture early skills related to smaller sound units because rimes and phonemes awareness requiring manipulation tend to appear later in phonological awareness development Parameters of Phonological Awareness Tasks A wide range of tasks have been used in previous research to assess phonological awareness and considerable variability in performance between tasks has been observed (Chabon & Prelock, 1987). Certain parameters of the tasks influence the demands they place on abilities underlying phonological awareness such as speech perception and discrimination, short-term verbal memory, cognitive abilities, attention span, and communication abilities (McBride-Chang, 1995). The following sections describe the parameters ofthe phonological awareness tasks that can influence children s performance Verbal Instructions The vocabulary, utterance length, grammatical elements and conceptual level of the instructions given to the children play an important role in the comprehension of the task (Chabon & Prelock, 1987). Word stimuli can be visually presented in pictures to minimize the demands on verbal memory and make the tasks more concrete. In addition, training items can be provided in order to familiarize the child with the tasks and ensure comprehension. Thus, verbal instructions in tasks designed for preschoolers should be simple and provide them with visual support and training items.

123 Response Requirements Tasks that require a verbal production as a response may vary in the communication demands they impose (Chabon & Prelock, 1987). A yes / no type ofresponse is easier than those requiring an oral production. Spoken responses can also vary in complexity: repetition of one of the experimenter s words, production of a new word, or even of a non word. When stimuli are visuaiiy represented, non-verbal responses can be a good solution to encourage the participation of children who are reluctant to speak or who have expressive language and speech difficuities (Gillon, 2004). In order to be suitable for preschoolers, tasks shouid require simple responses Cognitive Demands Treiman & Zukowski (1996) and Yopp (1988) found that cognitive ioad may also influence performance on phonological awareness tasks: complex tasks requiring more steps to compiete increase demands on verbal short-term memory. Bali (1993) ciassified phonological awareness tasks in two categories: simple tasks that require one mental manipulation such as rhyme judgment, segmentation and blending tasks, and complex tasks that require more than one mental manipulation such as deietion, substitution and reversai tasks. Therefore, phonologicai awareness assessment instruments designed for preschooiers shouid target tasks with iower cognitive demands Iargeted Sound Unit It is usually recognized that it is easier to perform a task with larger rather than smalier sound units (Giilon, 2004). In fact, it is flot the size of the sound unit but rather its iinguistic level that influences the task difficuity (Treiman & Zukowski, 1996). Consequently, tasks at the syilable level wouid be easier than those at the rime level, and those at the rime level wouid be easicr than those at the phoneme levei. As seen in the previous phonoiogicai development section, researchers are flot unanimous about this

124 104 sequence when environmental linguistic influences, the level of intentionality and consciousness required by the task are taken into consideration. However, phonological awareness tasks designed for French-speaking preschooïers must involve syllables. Tasks involving rimes and phonemes, if chosen, should tap shallower levels of phonological awareness (e.g., using categorization), rather than deeper levels (e.g., using manipulation tasks) Linguistic Parameters of the Stimuli Linguistic characteristics of the stimuli are another important factor influencing children s performance in phonological awareness tasks (Chafouleas, VanAuken, & Dunham, 2001). Stahi and Murray (1994) found that linguistic complexity explained children s performance better that did the nature of the tasks used. The following sections describe the parameters that may influence linguistic complexity of the stimuli in phonological awareness tasks Lexical Status of Stimuli Both real words and non-words have been used in experimental phonological awareness tasks. With young chiidren, high frequency words are ofien used instead of non words to ensure that a clear phonological representation is available in long term memory (Fowler, 1991). However, these high-frequency words also have a strong semantic representation that can introduce biases in the tasks, as young chiidren may have difficulty separating the sound structure of the word from its meaning (van Kleeck, 1995). Courcy and Béland (1998) found that the use of non-words was effective in phonological awareness tasks for young chiidren. Using non-words stimuli thus seems to be more appropriate than using real words in order to avoid possible semantic biases.

125 Phonemic Length Tasks difficulty increases with number of phonemes in the stimuli. McBrideChang (1995) related this length effect to limited short-term verbal memory capacity. Consequently, shorter stimuli should precede longer ones within a task to gradually increase its complexity Location of the Targeted Sound Unit There is consensus in the research to date that sound units embedded in the middle of words are harder to perceive and manipulate than are those at the beginning or at the end of the stimuli (McBride-Chang, 1995; Stanovich et al., 1984). Primacy and recency effects in verbal short term memory would favor initial and final positions (Treiman, Berch, & Weathersont, 1993) and the higher level of coarticulation in the middle of the word would render units in this position less accessible (Stage & Wagner, 1992). The advantage of the initial position over the final position found in some studies (Stage & Wagner, 1992; Stanovich et al., 1984; Treiman et al., 1993) is not unanimous (see McBride-Chang, 1995). Therefore, testing sound units in the middle of the word should be avoided when designing tasks for young children. The focus should be on both the initial and the final positions Syllabïc Structure The presence of consonant clusters in the syllabic structure of the stimuli makes phonological tasks more difficult to complete (McBride-Chang, 1995). This effect is related to the fact that consonant clusters may cause confusion in speech perception. Further, phonological tasks involving closed syllables might be harder, especially for younger children because the frencli language displays a higher frequency of open syllables in words. Therefore, in order to gradually increase a task complexity, stimuli with a simple open syllabic structure should precede those with more complex syllabic structures within the task.

126 Nature of Phonemes McBride-Chang (1995) reported that the acoustic properties of phonemes influence phonological awareness tasks because of their impact on speech perception. Continuant consonants like liquids (e.g. li, RI) and fricatives (e.g. ls, vi) are easier to identify and manipulate than are stops (e.g. /p, dl) (McBride-Chang, 1995; Stahl & Murray, 1994). Consequently, stimuli involving continuants should precede those involving stops in order to gradually increase complexity within a task. Treiman, Broderick, Tincoff, and Rodriguez (1998) also found that consonants that differ only in voicing (e.g. ltl versus /d/) are harder to compare. Thus, in tasks such as rhyme judgment or initial phoneme categorization, comparison of stimuli with consonants differing in many parameters (e.g. voicing, placement, and manner) should precede those with consonants differing only in voicing Phonological Awareness Tasks for Preschoolers in Frencli Most of the phonological awareness tasks cunently available in French are embedded in more general norm-referenced tests and tend not to be sensitive to intervention effects. In addition, most tests for children were consfructed for kindergarteners and school-aged children. The same is true with criterion-referenced tasks used in studies conducted in French (e.g. Boudreau, Giasson, & Saint-Laurent, 1999; Courcy et al., 2000; Duncan et al., 2006; Lecocq, 1991). Moreover, most of the available tasks do flot consider simultaneously the specific characteristics of the french language, phonological awareness development in children, task parameters, and linguistic parameters of the stimuli. Consequently, the current study addressed three research questions: (a) What combination of phonological awareness tasks taking into account french language characteristics, phonological awareness development in chiidren, parameters of tasks, and linguistic parameters of the stimuli is suitable for preschoolers and is sensitive to developmental growth? (b) Is this combination of tasks sensitive to

127 107 intervention effects? (e) What are some the main psychometric properties of these tasks? A series of two experiments was conducted to address these questions. 5.3 Experiment Metliods Study Design The goal of the first experiment was to design phonological awareness tasks that took into account French language characteristics, phonological awareness development in chiidren, task parameters, and linguistic parameters of the stimuli. It examined which combination of these tasks was both suitable for preschoolers and sensitive to developmental growth. It provided preliminary information about the psychometric properties of these tasks for preschoolers from middle and high social classes. A cross sectional design was used to measure phonological awareness across three age groups of preschoolers: 3, 4 and 5 year-olds Participants The children were recruited in ten public subsidized child care centers in middle to high socioeconomic status (SES) neighborhoods of Québec City and of Montréal, Québec, Canada. Participants met the following inclusion criteria: french as first language (i.e. exposed to French 90% of the time), language development and hearing perceived as normal by the parents, and reading not yet acquired according to the parents. The chiidren s age feu in one of the three age groups at testing: from 32 to 40 months (3 year-old group), from 44 to 52 months (4 year-old group), and from 56 to 64 months (5 year-old group). Forty-four chiidren were selected: 12 in the 3-year-old group, 12 in the 4-year-old group, and 10 in the 5-year-old group.

129 109 segmentation, (e) syllable deletion, (f) syllable inversion, and (g) initial consonant categorization. These tasks were chosen for their developmental appropriateness and were ordered following an increasing level of difficulty according to the literature reviewed in the previous section. The tasks for rhyme judgment, initial syllable categorization and initial consonant categorization involved comparison of only two stimuli at a time to avoid overtaxing of verbal short-term memory. The instrument involved the levels of rime, syllable, and phoneme in order to cover ah of the sound units in which phonological awareness development occurs. A greater proportion oftasks involved the syllable level because ofthe syhlable-timed nature of the French language. Each task included 3 practice items and 10 assessment items. Ten is considered to be a sufficient number of items in each task in order to measure phonological awareness rehiably while keeping young children s attention and focus (Stanovich, Cunningham, & Cramer, 1984). Attention to the vocabulary and the sentence complexity used made the instructions simple and clear. The words rhyme, syllable and sound were used but they were explained (e.g. a syllable is a small chunk of a word) and visually represented by wooden blocks. Manipulation of these blocks made the task instruction more concrete (e.g. separation of two blocks to illustrate syllable segmentation). The first two and the hast task required a yes/no type of response and the distribution of each type of response (yes vs. no) was randomly ordered. The five other tasks required oral production. However, efforts were made to reduce the articulatory complexity of the requested answers by avoiding phonemes that emerge later in chiidren s oral production (e.g. /Ç/ and /3/) and consonant clusters with great distance between articulation place (e.g. /tr/ or /kl/). The tasks used multisyhlabic non-words as stimuli to reflect the multisyllabic nature of words in French and to control for possible lexical and semantic biases. The phonemic length, the location of the target sound unit, the syllabic structure and the nature of the phonemes in the non-words were manipulated in order to increase the difficulty level

130 110 within each task as proposed in the literature reviewed in the previous section. For the categorization tasks (rhyme judgment, initial syllabie categorization, and initial consonant categorization), the following mies were appiied: (a) phonemic length: from 4 to 5 phonemes; (b) syllabic structure of target unit: from a simple consonant vowel (CV) structure to complex CVC and CCVC structures; (c) nature of the consonant: for different pairs, from high contrast (voiced fricative vs. voiceless stop) to low contrast (voiceless stop vs. voiceless stop) and for similar pairs, from voiced fricative to voiceless stop. for the manipulation tasks (syliable blending, segmentation, deletion and inversion), the following rules were applied: ta) phonemic length: from 4 to 6 phonemes and from 2 to 3 syllables in the segmentation task, (b) syllabic structure: from simple CV$ (syllable boundary) CV to complex CV$CCV, CVC$CV, CCV$CCV, CVC$CVC and CV$CV$CV (for blending and segmentation only); (c) nature of the consonant: different place of articulation but similar voicing in each syllable to ease production of the response, and (d) location of the sound unit to delete for syllable deletion task only: from initial to final. Ail the tasks are available from the first author. To provide information about the concurrent validity of the tasks, the receptive vocabulary test Échelle de vocabulaire en images Peabody (ÉVIP) (Dunn, Thériault Whalen, & Dunn, 1993) was chosen because of its well known validity and reliability in french, and also because of the positive relationship between vocabulary and phonologicaï awareness development (Metsaia & Waliey, 1998). A positive correlation is expected between the ÉVIP and the phonological awareness tasks, but given that they do not assess the same constmct, a large conelation coefficient is flot expected Procedures first, the ÉVIP was administered to the children. The phonological awareness tasks were then administered through a puzzle game in order to reinforce children s participation. Afier the completion of each task, the child received a different box containing pieces of a

131 111 puzzle. The completion ofall tasks was required to complete the puzzle. Each response was worth 1 point for a maximum of 10 points for each task, and a total test score of 70 points. Verbal reinforcement was given regardless ofthe correctness ofthe child s response during the test. Feedback on correctness was provided for the three practice items oniy. No repetition of the stimuli was permitted. After five consecutive incorrect responses or two refusals from the child within a task, the experimenter gave the gifi box to the child and went on to the next task. Task administration was stopped afler three consecutives tasks in which the child scored 0. The assessments were conducted in the children s childcare centers, in a separate room where visual and auditory distracters were reduced. The second and third authors each administered haif of the assessments. They were graduate students trained by the first author to systematically use the verbal instructions with non-verbal cues that were described on the phonological awareness tasks form. The examiners fihled out the response forms on site. The assessments were recorded on audiotape for inter-rater reliability measures of the manipulation tasks requiring oral production. Inter-rater reïiability was established based on 70% of the tasks involving production by the child. The two experimenters listened to recording of the assessment sessions they did not perform. A 97% agreement rate on item scoring was obtained Resuits Sensitivity Table II shows the mean scores and standard deviations on the tasks across the three groups. Non parametric tests were used (Kruskal-Wallis H and Mann-Whitney U) for comparison analyses because the normal distribution of the data and the equality of the variances across groups could flot be assumed. A difference was found among the three groups in total score, H(2) = 16.82,p <.01. Post hoc comparisons were made with the alpha level set at.017 (Bonferroni correction). Total scores were higher for the 5 year-olds than those for the 4 year-olds (U= 2O.5,p <.01), and the 3 year-olds (U= 0.5,p <.01). No

134 114 reliability coefficient of at least.85. A significant positive non parametric correlation using Kendall s t was found between the total phonological awareness score and the ÉVIP raw score, t =.42,p < Discussion The phonologicai awareness tasks were sensitive to developmental growth between 4 and 5 year-olds. The tasks were too difficult for most of the 3 year-olds who performed at floor level or at chance on some tasks. The medium to large intercorrelations suggest that ail tasks tapped into a common underlying construct. The analyses revealed good psychometric properties: there was an excellent internai consistency and good concurrent validity with the ÉVIP. As expected, the medium level of the correlation between the phonological awareness tasks and the ÉVIP suggests that the two tests did not measure the same underlying construct: phonological awareness versus receptive vocabulary. Given that administration time could be as long as 45 minutes, a shorter version of phonological awareness assessment was needed to make it more suitable for young children. The syllabie inversion task was eliminated because only 2 children passed at least 1 item in this task. The initial syllable categorization task was also eliminated because it did discriminate between children from different age groups. In order to reflect phonological awareness at ah sound unit leveis, the rhyming judgment and the initial consonant categorization tasks were retained. Among the three remaining tasks involving syllables, only segmentation and deletion were retained. Segmentation and biending are similar tasks involving opposite mental operations and segmentation was retained because it was more discriminative than blending across the age groups, according to the H values of the statistical tests performed to compare between age groups. Therefore, four tasks were chosen to form the Épreuve préscolaire de conscience phonologique (ÉPCP): ta) rhyme judgment, (b) initial consonant categorization, (c) syllable segmentation, and (d) syllable deletion. Given that some chiidren struggled with the shift in

135 115 response paradigm between categorization tasks requiring a yes / no type of response and manipulation tasks requiring oral production, rhyme judgment and initial consonant categorization tasks preceded syllable segmentation and deletion tasks. In addition, a few non-word stimuli were modified because they resembled real words. Finally, modifications were made in the instructions: redundancy in the explanations was reduced and the 3 practice items were changed for 2 training items and 4 practice items. In the training items, the experimenter gives examples of correct answers. In the practice items, the child is asked to give an answer and corrective feedback is provided by the experimenter. The child has to give two correct answers in the practice items before being presented with the 10 items of the task. If he does flot give two correct answers, the task is skipped. In order to verify if the ÉPCP is sensitive to phonological awareness growth due to intervention, a subset of data were analyzed from a larger study on the efficacy of an intervention program for at-risk French-speaking preschoolers (Lefebvre, Trudeau, & Sutton, 2007). Psychometric properties of the ÉPCP were also examined in these preschoolers who were from lower social classes. 5.4 Experiment Methods Study Design The second experiment used a control-group pretest-posttest design. Low SES chiidren were recmited from 4 childcare centers. Each of 2 sites was randomly assigned to either an experimental or a control group. The control group received an evidence-based shared storybook reading program fostering explicitly oral language and print awareness skills. The experimental group received an enhanced version of the shared storybook

136 116 reading program which explicitly targeted phonological awareness in addition to oral language and print awareness skills. Both programs lasted 10 weeks Participants Table IV: Characteristics of Participants in Experiment 2 Group Variables Experimental (n = 10) Control (n = 13) Gender Number of males 6 8 Number of females 4 5 Number with language delay 4 7 Mean age in months ($D) 57.1 (4.3) 57.5 (3.6) Vocabularyscorea(SD) 99.5 (14.3) 100.9(18.5) Mean annual income in $ (SD) (12463) (8514) Mean parent education ($D) 0.7 (0.8) 0.7 (0.9) Standardized receptive vocabulary score on ÉVIP. O = high school non completed; 1 = high school completed; 2 = college completed; 3 = university degree completed. The children were recruited in publicly subsidized chuldcare centers of low SES neighborhoods of Québec City, Québec, Canada. Participants met the following inclusion criteria: French as first language (i.e. exposed to French 90% of the time), reading not yet acquired according to the parents, normal cognitive development and hearing status, and annual family income below Statistics Canada s low-income cut-offs (Statistics Canada, 2006). Twenty-three chuldren were recruited: 10 in the experimental group and 13 in the control group. Their characteristics are shown in Table IV. There were no differences on

137 117 any variable: age, t(21) = 0.22, p =.83; sex distribution, 2(1 N = 23) = O.Ol,p =.94; distribution of chiidren with language delay, x2( 1, N = 23) = 0.43, p.51; chiid vocabulary scores, t(21) = 0.20, p =.84; annual family income (U = 64.00, p =.95); and parent education (U 62.SO,p.87) Procedures Before and after the 10-week intervention program, ail chiidren were met for an individual assessment of oral language and emergent literacy skills that inciuded the administration of the ÉPCP. The ÉVIP was also administered as a pretest onïy. The ÉPCP was again administered through a puzzle game. Each answer was worth 1 point for a maximum of 10 points by tasks, for a total test score of 40 points. Positive verbal reinforcement was given, but no repetition of the stimuli was permitted. After 5 consecutive incorrect answers or 2 refusais from the child, the task was skipped. Trained graduate students and the first author administered the assessments in the children s child care centers, in a separate room where visual and auditory distracters were reduced. The post intervention assessments were performed by one trained graduate student who was blind to the interventions. The response forms were completed on site. The assessments were recorded on audiotape for inter-rater reliability measures of the tasks requiring oral production. A 96% agreement rate was obtained Resuits Sensïtivity A t-test confirmed that the groups obtained equivalent scores on the ÉPCP before intervention, t(21) = 0.46, p =.65. A series ofpaired t-tests were used to verify whether the ÉPCP could detect improvement in phonological awareness measures due to intervention. The experimental group had a mean score of 15.2 (3D = 5.9) at pretest, and improved to 29.5 (3D = 5.6) at posttest on the ÉPCP. A significant improvement was found for this

138 118 group with a large size effect according to Cohen s criteria (1988), t(9) = 8.98,p <.01, d = The control group obtained a mean score of 13.9 (SD = 7.8) at pretest and 17.8 (SD = 8.1) at posttest on the ÉPCP. A significant improvement was also found in the control group, but with a smaller effect size, t(12) = 2.l9,p =.049, d = Posttest scores ofthe experimental group were higher than those of the control group, t(2 1) = 3.91,p < Reliabïlity and Concurrent Validity The assessment instrument provided excellent Cronbach s xs before and afier the intervention (.86 and.91 respectively). The correlation between ÉPCP scores before intervention and the ÉVIP raw scores was similar to that obtained in Experiment 1 ( r =.40, p.01). = Discussion The ÉPCP was sensitive to intervention effects in low SES preschoolers even when the analyses included a small number of children. A larger effect size was found when the intervention explicitly addressed phonological awareness. Reliability and concurrent validity remained good despite the modifications of the tasks following Experiment General Discussion Sensitivity and Psycliometric Properties of the Tasks This study extends the scientific literature related to phonological awareness tasks for French-speaking preschoolers. The results indicate that the ÉPCP is sensitive to improvement in phonological awareness due to development or intervention even when groups analyzed are small (n from 10 to 13 in each group). As in Lonigan et al. s study (1998) with English-speaking children, phonological awareness tasks in French can be sensitive in the preschool years. The multiple tasks included in the ÉPCP present medium

139 119 to high correlations which suggest that they tap into the same underlying construct. These correlations among tasks reflect the results obtained in many other studies (e.g. McBride Chang, 1995; Stanovich et al., 1984; Yopp, 198$). The internai consistency and concurrent validity of the ÉPCP remained good across social classes. The combination of tasks may explain why the Cronbach Œ coefficients in the current study were higher than in most studies analyzing single multiple item tasks (e.g. Stanovich et al., 1984; Yopp, 198$). Using a combination of tasks involving different sound units and mental operations may also make the ÉPCP more suitable for young chiidren. Single task instruments such as the initial phoneme oddity task developed by Boudreau et al. (1999) for french-speaking kindergarteners are flot sensitive in younger children. Overall, the current study supports the notion that the ÉPCP can yield relevant information about phonological awareness development in preschoolers Limitations of the Study The tasks included in the ÉPCP were too difficult for 3 year-olds. Modifications would be needed in order to use this instrument with children of this age. Concurrent validity was established with a vocabulary test. It would be more convincing to use another phonological awareness test if it was available or, at least, a test tapping skills more directly linked to phonological awareness such as short-term verbal memory. Further research on other psychometric characteristics such as predictive validity or test-retest reliability would provide more evidence of the reliability and validity of the ÉPCP. Finally, further research with larger samples of children and from more geographically diverse participant groups is needed in order to provide normalization data useffil for detecting children who experience delay in their phonological awareness development.

140 Clinical implications The ÉPCP is an instrument sensitive to phonological awareness in 4- and 5 year-old French-speaking preschoolers that provides good psychometric properties. It shows some potential to be used in research or in clinical settings to measure phonological awareness training efficacy before kindergarten, even in relatively small groups. The ÉPCP also has a potential utility in older chiidren, because no ceiling effects were obtained in the current study. However, more research is needed with larger sample of chiidren to confirm the clinical value ofthe ÉPCP.

145 Author Note Pascal Lefebvre, Centre de recherche CHU Ste-Justine, Université de Montréal, Montréal, Québec, Charlotte Girard and Karine Desrosiers, Université Lavai, Programme d orthophonie, Québec City, Québec, Canada; Natacha Trudeau and Ann Sutton, École d orthophonie et d audiologie, Centre de recherche du CHU Ste-Justine, Université de Montréal, Montréal, Québec, Canada. This study was supported by funding by Université Lavai, Canadian Child Health Clinician Scientist Program, Abitibi-Consolidated and Centre de recherche du CHU Ste Justine. We would like to thank ail the chiidren, the families and the child care centers who participated in the study. The first author is a CIHR Strategic Training Fellow in the Canadian Chiid Health Clinician Scientist Program (CCHCSP). This article is part of the doctoral thesis of the first author. Aspects of this work were presented at the annual convention of the American Speech-Language-Hearing Association in November Correspondence conceming this article should be addressed to Pascal Lefebvre, Centre de recherche du CHU Ste-Justine, Centre de réadaptation Marie-Enfant, 5200 Bélanger Est, Montréal, Québec, Canada, HiT 1C9.

172 III You are a Specch-Lan%uage Pathologist and work with preschoolers? We need your collaboration for a survey on prevention ofwritten language difficulties In his doctoral studies, Mr. Pascal Lefebvre, SLP, is interested in preventive practices regarding written language in speech-language pathology. To get a better picture of what really happens among speech-language pathologists in this domain, he invites you to participate to the Survey on Canadian Preventive Practices regarding Written Language Difficulties. If you work with 0-6 year-old preschool chiidren including those in kindergarten, you may participate in this study.. Even if you don t work precisely in emergent literacy or in prevention of written language difficulties, you may participate. We need as much answers from Speech-Language pathologists working with preschoolers as possible to capture a real picture of the situation. Even if you work only part time with preschoolers, you may participate. If you only work with children in 1st grade or more, adolescents, adults, or the elderly, you cannot participate. This survey takes only 10 minutes to fili out on your computer! Follow these steps: You wish to participate? 1) Go to the following website: You will be able to download a copy ofthe french or English consent form, and ofthe survey itself. 2) You must print and read the consent form, and sign the last page 3) You must fil out the survey on your computer, and print it. 4) The two documents (the signed consent form and the survey) can be sent by fax to Pascal Lefebvre at: (514) or by regular mail to: Centre de recherche de l Hôpital Ste-Justine, C.R. Marie-Enfant, AJS Pascal Lefebvre, 5200 Bélanger Est, Local GR-106, Montréal, Qc,, HiT 1C9 Please keep a copy of the information and consent forms. You are absolutely free to participate or not to this survey. Your participation will help improve our profession in Canada. Thank you, Pascal Lefebvre Doctorate Student, Biomedical Sciences, option Speech-language Pathoïogy Université de Montréal/Centre de recherche de l Hôpital Ste-Justine

177 VIII HÔPITAl., r:.- p -- SAIN I ]i-jus I INE.--.-,c:- -r r r. [j tfltt hopirilirr unnjer.çztau-e rc n it - -- ru tru.- u. u:, u:r,,rulrtns,wnrcnn. INFORMATION AN]) CONSENT FORMS The study titie Survey on Canadian Speech-Language Pathology Practices regarding Prevention of Written Language Difficulties. People in charge of the study Pascal Lefebvre, doctorate student in Biomedical Sciences, option speech-language pathology Natacha Trudeau Ph.D,. researcher at the Centre de recherche l Hôpital Sainte-Justine Invitation to participate in a study The Centre de recherche de l Hôpital Sainte-Justine de Montréal is participating in a research project which is exploring preventive practices of speech-language pathology regarding emergent literacy in chiidren. We are seeking your participation in the first stage of this research project which aims to document dunent practices of Canadian Speech Language Pathologists regarding to prevention of reading and writing leaming difficulties. We invite you to read this information and consent form to decide if you are interested in participating in this study. What is the nature of thîs study? Speech-language pathologists are concemed with prevention, evaluation and treatment of oral and written communication difficulties. Recently, they have been more and more involved with evaluation and treatment of reading and writing leaming difficulties of school-age chiidren. However, littie information is available about the current practice of speech-language pathologists in prevention of reading and writing leaming difficulties in younger children. The present study aims to document preventive practices of speech language pathologists regarding emergent literacy. This information will be necessary to enhance speech-language pathoïogy practice in this area. With the help of a written questionnaire sent to Canadian speech-language pathologists who work with O-6 year-old preschoolers including those in kindergarten, we are attempting to leam if preventive speech-language pathology practice regarding emergent literacy is widespread or flot. We hope to obtain information about the nature of preventive interventions and the target chuidren. FinalÏy, we would like to find information about the training of speech-language pathologists in this domain.

178 How wîil the study unfold? A questionnaire wlll be used to collect data. It will be available on internet to speech language pathologists members of CASLPA and/or OOAQ who work with 0-6 year-old preschoolers including those in kindergarten. The questionnaire can be completed in 5 minutes on the computer: you must check the answer which best corresponds to your professional practice or select a given answer in a scroll-down menu. You must then print the consent form (31 page ofthis form) as well as the completed questionnaire. Please sign the consent form and fax both the consent form and questionnaire to Pascal Lefebvre at: (514) or mail to: Centre de recherche de l Hôpital Ste-Justine, C.R. Marie-Enfant, AIS Pascal Lefebvre, 5200 Bélanger Est, Local GR-106, Montréal, Qc, HiT 1C9. Keep a copy ofboth the information and consent forms. What are the advantaes and the benefits? There are no direct or immediate benefits from your participation. However, your participation will allow us to document speech-language pathology practice in regard to prevention in emergent literacy, which could eventually improve the training and the practice in this area and prevent chiidren s reading and writing difficulties. What are the risks and drawbacks? There are no risks involved in participating in this study. The only drawback of your participation is the time necessary to fill out the questionnaire (approximately 5 minutes). How is confidentialïty ensured? Your answers on the questionnaire will remain confidential unless you have given sufficient authorisation or there is an exception to the law. Your consent form will receive a code. Your questionnaire will be identified only by this code to ensure your anonymity. The consent form that allows you to be identffied will be kept separately. Only the student, his doctorate supervisor and the secretary of the research center will have access to the completed questionnaires and consent forms. These documents will be kept strictly confidential in a locked cabinet at the Laboratoire des technologies pour la communication at the Centre de recherche de l Hôpital Ste-Justine for a period of ten years after the completion of the study. The resuits may be published or presented in a scientific conference, but the participants confidentiality will be preserved. Researchers responsibility By signing this form, you do flot renounce any of your rights. You also do flot release the researchers of their legal or professional responsibilities upon the onset of a situation that could cause you prejudice. Freedom of participation Your participation in this study is free and voluntary. You may refuse to participate or end your participation, without consequence, without having to provide any justification. Ix

179 X In case of questions or of difficultïes, wïth whom can I communicate? for more information concerning this research, you can contact the researchers responsible for the study at the Centre de recherche l Hôpital Sainte-Justine: Pascal Lefebvre : (514) poste 8639 ou Natacha Trudeau: (514) , poste b obtain more information conceming your rights while participating in this study, or upon the onset of any problems concerning the conditions in which the study occurs, you may contact the ombudsman ofthe Hôpital Ste-Justine, at (541)

180 XI H Ôp ITA L SAINT-Jus i INE I1! CtfltT hlpî&2l2jr î unkier.ritain ière entant [-E E ET; rt r;.rvrnrcznt u CrflTrZ;Zr[:JarflUrZttir.Zr Study participants CONSENT FORM I have been informed ofthe nature and the unfolding ofthe study called «Survey on Canadian Speech-Language Pathology Practices regarding Prevention of Written Language Difficulties». I have read the information and consent forms and I have kept a copy for myseif. If I had any questions about this study, I spoke with someone responsible for the study who was able to give me satisfactory answers. Afier consideration, I accept to participate in this study. Participant s Name (printed letters) Signature of the participant Date Commitment of the researcher or of the dele2ated Person I certify that I explained in writing to the participant the terms of the present form, the nature and the method of the study, answered any questions that he/she may have asked and clearly indicated that he/she is free to abandon his/her participation in the study. The research team is committed to respecting what was recognized in the information and consent forms. Pascal Lefebvre, doctorate student Name and Position (printed letters) Signature of the researcher or delegate who received the consent Date